Hypercontracting (nutcracker) esophagus

Hypercontracting (nutcracker) esophagus is a motility disorder of the esophagus. This condition is primarily diagnosed with manometry with high intra-esophageal pressure and normal peristalsis. Most patients will have a normal barium swallow.

Hypercontracting esophagus ("nutcracker esophagus") differs from diffuse esophageal spasm (corkscrew esophagus).


Hypercontracting esophagus occurs in 10% of patients with non-cardiac chest pain.


Clinical presentation

Presentation includes chest pain, dysphagia, and gastro-esophageal reflux disease.



Etiology is unknown but may be related to gastro-esophageal reflux or stress .

Radiographic features


A barium swallow is usually normal. A minority of patients may demonstrate features of non-specific esophageal motility disorder .

Differential diagnosis

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