[Nutcracker esophagus. Analysis of 80 patients].

Background: The nutcracker esophagus, a primary motor disorder, is frequently associated with noncardiac chest pain.

Aim: To study the clinical, endoscopic, manometric, and pathological features and 24 h acid reflux in patients with nutcracker esophagus.

Patients And Methods: Eighty patients (63 females, aged 26 to 70 years) with nutcracker esophagus, defined as the presence of contraction waves of more than 180 mmHg in the esophageal manometry, were studied. All were subjected to an upper gastrointestinal endoscopy, 24 h esophageal pH monitoring and a new manometric study.

Results: Eighty percent of patients had symptoms suggestive of gastroesophageal reflux, 31% had retrosternal pain and 25% had dysphagia. Upper endoscopy was normal in 41% and showed erosive esophagitis or Barrett esophagus in 27%. Fifty percent of patients had an abnormal acid reflux. There were no significant differences in manometric parameters between patients with and without acid reflux.

Conclusions: Symptoms of gastroesophageal reflux not necessarily mean that a pathological reflux is present. Primary motor disorders of the esophagus may cause similar symptoms.