Summary
Nutcracker esophagus is essentially a manometric diagnosis characterized by high-amplitude, often prolonged duration of peristaltic contractions in the distal two thirds of the esophagus. Its association with noncardiac chest pain and/or dysphagia has been recognized and reported by numerous esophageal motility laboratories. There are very few long-term studies of the natural history of this abnormality. We report a patient who presented with dysphagia and, on initial investigation, was found to have classical nutcracker esophagus. On reinvestigation three years later, however, he had developed achalasia of the cardia. The transition from nutcracker esophagus to achalasia has not previously been reported.
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References
Brand DL, Martin D, Pope CE II: Esophageal manometrics in patients with angina-like chest pain. Am J Dig Dis 22:300–305, 1977
Benjamin SB, Gerhardt DC, Castell DO: High amplitude, peristaltic esophageal contractions associated with chest pain and/or dysphagia. Gastroenterology 77:478–483, 1979
Traube M, Albibi R, McCallum RW: High-amplitude peristaltic esophageal contractions associated with chest pain. JAMA 250:2655–2659, 1983
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Castell DO: The nutcracker esophagus and other primary esophageal motility disorders.In Esophageal Motility Testing. DO Castell, JE Richter, CB Dalton (eds). New York, Elsevier Science, 1987, pp 130–138
Richter JE, Wu WC, Johns DN, Blackwell JN, Nelson JL, Castell JA, Castell DO: Esophageal manometry in 95 healthy adult volunteers. Variability of pressure with age and frequency of “abnormal” contractions. Dig Dis Sci 32:583–592, 1987
Lydon SB, Dodds WJ, Hogan WJ, Arndorfer RC: The effect of manometric assembly diameter on intraluminal esophageal pressure recording. Dig Dis Sci 20:968–970, 1975
Wilson JA, Pryde A, Macintyre CCA, Heading RC: Normal pharyngoesophageal motility. A study of 50 healthy subjects. Dig Dis Sci 34:1590–1599, 1989
Traube M, McCallum RW: Comparison of esophageal manometric characteristics in asymptomatic subjects and symptomatic patients with high-amplitude esophageal peristaltic contractions. Am J Gastroenterol 92:831–835, 1987
Drane WE, Johnson DA, Hagan DP, Cattau EL: “Nutcracker” esophagus: Diagnosis with radionuclide esophageal scintigraphy versus manometry. Radiology 163:33–37, 1987
Cohen S: Esophageal motility disorders and their response to calcium channel antagonists. The sphinx revisited. Gastroenterology 93:201–203, 1987
Dalton CB, Castell DO, Richter JE: The changing faces of the Nutcracker esophagus. Am J Gastroenterol 83:623–628, 1988
Janssens J, Vantrappen G, Ghillebert G: 24-Hour recording of esophageal pressure and pH in patients with noncardiac chest pain. Gastroenterology 90:1978–1984, 1986
Richter JE, Castell DO: 24 hour ambulatory oesophageal motility monitoring: How should motility data by analysed? Gut 30:1040–1047, 1989
Nagler R, Spiro HM: Serial esophageal motility studies in asymptomatic young subjects. Gastroenterology 41:371–379, 1961
Clouse RE, Lustman PJ: Psychiatric illness and contraction abnormalities of the esophagus. N Engl J Med 309:1337–1342, 1983
Richter JE, Obrecht WR, Bradley LA, Young LD, Anderson KO: Psychological comparison of patients with nutcracker esophagus and irritable bowel syndrome. Dig Dis Sci 31:131–138, 1986
Richter JE, Castell DO: Surgical myotomy for nutcracker esophagus, to be or not to be? Dig Dis Sci 32:95–96, 1987
Landau D, Clouse RE: Repeated esophageal manometrics in patients with the nutcracker esophagus. Gastroenterology 82:1111, 1982
Narducci F, Bassotti G, Gaburri M, Morelli A: Transition from nutcracker esophagus to diffuse esophageal spasm. Am J Gastroenterol 80:242–244, 1985
Traube M, Aaronson RM, McCallum RW: Transition from peristaltic esophageal contraction to diffuse esophageal spasm. Arch Intern Med 146:1844–1846, 1986
Kramer P, Harris LD, Donalson RM: Transition from symptomatic diffuse spasm to cardiospasm. Gut 8:115–119, 1967
Vantrappen G, Janssens HOJ, Hellemans HO, Coremans G: Achalasia, diffuse esophageal spasm, and related motility disorders. Gastroenterology 76:450–457, 1979
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Anggiansah, A., Bright, N.F., McCullagh, M. et al. Transition from nutcracker esophagus to achalasia. Digest Dis Sci 35, 1162–1166 (1990). https://doi.org/10.1007/BF01537590
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DOI: https://doi.org/10.1007/BF01537590