Nutcracker esophagus history and symptoms

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Nutcracker esophagus Microchapters


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Historical Perspective




Differentiating Nutcracker esophagus from other Diseases

Epidemiology and Demographics

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Natural History, Complications and Prognosis


History and Symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


History and Symptoms

Time space graph of normal peristalsis. Nutcracker esophagus shows higher amplitude contractions (Z-axis) that take longer to pass (X-axis)

Nutcracker esophagus is characterized as a motility disorder of the esophagus, meaning that it is caused by abnormal movement, or peristalsis of the esophagus.[1] Patients with motility disorders present with two key symptoms: either with chest pain (typically given termed as non-cardiac chest pain as it is esophageal in origin), which is usually found in disorders of spasm, or with dysphagia, or difficulty swallowing. Nutcracker esophagus can present with either of these, but chest pain is the more common presentation.[2] The symptoms of nutcracker esophagus are intermittent, and may occur with or without food.[1] Rarely patients can present with a sudden obstruction of the esophagus after eating food (termed a food bolus obstruction, or the steakhouse syndrome) requiring urgent treatment.[3][4] The disorder also does not progress to produce worsening symptoms or complications, unlike other motility disorders, such as achalasia, or anatomical abnormalities of the esophagus, such as peptic strictures or esophageal cancer.[5]

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.[1][6]

Nutcracker esophagus may also be associated with the metabolic syndrome,[7] obesity,[8] and gastroesophageal reflux disease.[9] It is uncertain what the effects of treating the underlying conditions will have on improvement of symptoms.[10] The incidence of nutcracker esophagus in all patients is uncertain.


  1. 1.0 1.1 1.2 Tutuian R, Castell D (2006). "Esophageal motility disorders (distal esophageal spasm, nutcracker esophagus, and hypertensive lower esophageal sphincter): modern management". Curr Treat Options Gastroenterol. 9 (4): 283–94. PMID 16836947.
  2. Fass R, Dickman R (2006). "Nutcracker esophagus--a nut hard to swallow". J Clin Gastroenterol. 40 (6): 464–6. PMID 16825926.
  3. Breumelhof R, Van Wijk H, Van Es C, Smout A (1990). "Food impaction in nutcracker esophagus". Dig Dis Sci. 35 (9): 1167–71. PMID 2390932.
  4. Chae H, Lee T, Kim Y, Lee C, Kim S, Han S, Choi K, Chung I, Sun H (2002). "Two cases of steakhouse syndrome associated with nutcracker esophagus". Dis Esophagus. 15 (4): 330–3. PMID 12472482.
  5. Dalton C, Castell D, Richter J (1988). "The changing faces of the nutcracker esophagus". Am J Gastroenterol. 83 (6): 623–8. PMID 3376915.
  6. Adler D, Romero Y (2001). "Primary esophageal motility disorders". Mayo Clin Proc. 76 (2): 195–200. PMID 11213308.
  7. Börjesson M, Albertsson P, Dellborg M, Eliasson T, Pilhall M, Rolny P, Mannheimer C (1998). "Esophageal dysfunction in syndrome X.". Am J Cardiol. 82 (10): 1187–91. PMID 9832092.
  8. Hong D, Khajanchee Y, Pereira N, Lockhart B, Patterson E, Swanstrom L. "Manometric abnormalities and gastroesophageal reflux disease in the morbidly obese". Obes Surg. 14 (6): 744–9. PMID 15318976.
  9. Fang J, Bjorkman D (2002). "Nutcracker esophagus: GERD or an esophageal motility disorder". Am J Gastroenterol. 97 (6): 1556–7. PMID 12094884.
  10. Borjesson M, Rolny P, Mannheimer C, Pilhall M (2003). "Nutcracker oesophagus: a double-blind, placebo-controlled, cross-over study of the effects of lansoprazole". Aliment Pharmacol Ther. 18 (11–12): 1129–35. PMID 14653833.

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