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).

Epidemiology

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

Associations

Clinical presentation

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

Pathology

Etiology

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

Radiographic features

Fluoroscopy

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

Differential diagnosis