Nutcracker esophagus overview
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Nutcracker esophagus (diffuse esophageal spasm or corkscrew esophagus) is a disorder of the movement of the esophagus, and is one of many motility disorders of the esophagus, including achalasia and diffuse esophageal spasm. It causes difficulty swallowing, or dysphagia, to both solid and liquid foods, and can cause chest pain; it may also have no symptoms. Nutcracker esophagus can affect people of any age, but is more common in the 6th and 7th decades of life. The diagnosis is made by an esophageal motility study, which evaluates the pressure of the esophagus at various points along its length. 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 linked to the pressure of a mechanical nutcracker. The disorder does not progress, and is not associated with any complications; as a result, treatment of nutcracker esophagus targets control of symptoms only.
The cause of diffuse esophageal spasm is unknown. Very hot or very cold foods may trigger an episode in some people.
Differentiating Nutcracker esophagus overview from Other Diseases
Epidemiology and Demographics
Natural History, Complications, and Prognosis
History and Symptoms
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. Studies on endoscopic ultrasound show a slight trend towards thickening of the muscularis propria of the esophagus in nutcracker esophagus, but this is not useful in making the diagnosis.
Other Diagnostic Studies
Pneumatic dilatation of the esophagus, which is an endoscopic technique where a high-pressure balloon is used to stretch the muscles of the LES, can be performed to improve symptoms. In patients who have no response to medical or endoscopic therapy, surgery can be performed. A Heller myotomy involves an incision to disrupt the LES and the myenteric plexus that innervates it. It is used as a final treatment option in patients who do not respond to other therapies.
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