nutcracker esophagus

Nutcracker esophagus can present with either of these, but chest pain is the more common presentation.

Three other criteria for definition of the nutcracker esophagus have been defined.

Nutcracker esophagus can affect people of any age, but is more common in the 6th and 7th decades of life.

Nutcracker esophagus may also be associated with the metabolic syndrome, obesity, and gastroesophageal reflux disease.

Finally, trazodone, an anti-depressant that reduces visceral sensitivity, has also been shown to reduce chest pain symptoms in patients with nutcracker esophagus.

Rarely disorders of movement of the esophagus, such as nutcracker esophagus, can predispose to food bolus obstruction.

These include achalasia, diffuse esophageal spasm, nutcracker esophagus and hypertensive lower esophageal sphincter.

Barium swallow in nutcracker esophagus is also typically normal but may provide a definitive diagnosis if contrast is given in tablet or granule form.

Medical therapy for nutcracker esophagus includes the use of calcium-channel blockers, which relax the LES and palliate the dysphagia symptoms.

This has led to the thought the pathophysiology of nutcracker esophagus may be related to abnormalities in neurotransmitters or other mediators in the distal esophagus.

Castell also noted that the lower esophageal sphincter relaxes normally in nutcracker esophagus, but has an elevated pressure of greater than 40 mm Hg at baseline.

As GERD is associated with nutcracker esophagus, it has also been hypothesized that the alterations in nitric oxide and other released chemicals may be response to reflux.

Esophageal motility disorder - (Nutcracker esophagus, Achalasia, Diffuse esophageal spasm, GERD)

Pathology specimens of the esophagus in patients with nutcracker esophagus show no significant abnormality, unlike patients with achalasia where destruction of the Auerbach's plexus is seen.

Studies on endoscopic ultrasound show slight trend toward thickening of the muscularis propria of the esophagus in nutcracker esophagus, but this is not useful in making the diagnosis.

The term "nutcracker esophagus" comes from the finding of increased pressures during peristalsis, with a diagnosis made when pressures exceed 180 mmHg; this has been likened to the pressure of a mechanical nutcracker.

Many patients with nutcracker esophagus do not have any symptoms at all, as esophageal manometry studies done on patients without symptoms may show the same motility findings as nutcracker esophagus.

Endoscopy is typically normal in patients with nutcracker esophagus; however, abnormalities associated with gastroesophageal reflux disease, or GERD, which associates with nutcracker esophagus, may be seen.

It is usually associated with diseases that narrow the lumen of the esophagus, such as eosinophilic esophagitis, Schatzki rings, peptic strictures, webs, or cancers of the esophagus; rarely it can be seen in disorders of the movement of the esophagus, such as nutcracker esophagus.