Content area
Full Text
Dysphagia 22:245250 (2007) DOI: 10.1007/s00455-007-9081-8
Are There Any Dierences Between Nutcracker Esophagus With and Without Reux?
Luiz Filipe Duarte Silva, MD, MSc, and Eponina Maria de Oliveira Lemme, MD, PhD
Gastroenterology Division, University Hospital Clementino Fraga Filho, Medicine Faculty, Federal University of Rio de Janeiro, Rio de Janeiro, Brasil
Abstract. Nutcracker esophagus (NE) is a primary esophageal motor disorder, rst described in patients with noncardiac chest pain. In recent years NE has been associated with gastroesophageal reux disease (GERD). In this study we compare patients with NE with and without GERD, as dened by pHmetry or endoscopy, with respect to clinical, endoscopic, radiologic, and manometric ndings. Fifty-two patients with NE were studied. They were divided in two groups: GERD (1732.6%) and non-GERD (3567.4%) patients. Females predominated in both groups, with no signicant dierence in age (p > 0.05). Chest pain was the chief complaint in both groups (p > 0.05). Clinical ndings in patients with and without reux included chest pain (52.9% and 51.4%), dysphagia (58.8% and 42.8%), and heartburn (64.7% and 42.8%), followed by regurgitation, dyspepsia, ear, nose, and throat (ENT) complaints, respiratory symptoms, and odynophagia (p > 0.05). Erosive esophagitis was found in three patients (5.7%). There were no dierences between groups in the ndings of barium swallow studies and all manometric ndings were similar for both groups (p > 0.05). We conclude that there were no dierences in patients with NE with or without associated reux disease. It is important to diagnose reux properly so patients can be treated adequately.
Key words: Esophageal manometry Esophageal motility disorder Nutcracker esophagus Gastroesophageal reux Deglutition Deglutition disorders.
In 1977 Brand et al. [1] reported high peristaltic waves in the distal esophagus of patients with non-cardiac chest pain (NCCP) and called them symptomatic esophageal peristalsis. They were later renamed nutcracker esophagus (NE) [2]. Other studies described this abnormality as the most frequent motor disorder in patients with NCCP [3, 4] and that it could also be the cause of dysphagia [3, 5 7]. In recent years, heartburn was described as part of the clinical picture of these patients [4, 7] and some papers have shown a relation between NE and GERD, especially in NCCP patients [7, 8].
These ndings have therapeutic implications. NE is usually treated...