Gastroesophageal acid reflux in patients with nutcracker esophagus.
BACKGROUND
Hypertensive esophageal contraction, called nutcracker esophagus (NE), is the most common motility abnormality associated with cardiac-like chest pain. However, its significance for the development of symptoms has been a matter of controversy for decades, and recently it has been suggested that NE might represent a primarily acid-related esophageal disorder. The frequency of acid-related esophageal dysfunction is studied in an unselected group of patients with NE.


METHODS
During the period March 1993 to June 1998, 572 consecutive patients underwent esophageal manometry and 24-h pH monitoring.


RESULTS
A motility pattern consistent with NE was found in 45 subjects referred because of chest pain (n = 35), reflux dyspepsia only (n = 8) or epigastric pain (n = 2). Acid-related esophageal dysfunction was noted in 30 (70%) of the NE patients; abnormal acid exposure time (n = 21), esophagitis (n = 2) or positive symptom index (n = 7). In addition, an increased number of reflux episodes were found in another three subjects. NE was more prevalent in subjects referred for chest pain than in those referred for other symptoms (14.3% versus 4.5%; P < 0.0001) and, conversely, 78% of the patients with NE were referred because of chest pain.


CONCLUSIONS
Various aspects of acid-related esophageal dysfunction occur frequently in patients with NE, suggesting that acid may play a role in the development of symptoms in NE. Nonetheless, given its association with chest pain, NE could be a marker of a subgroup of patients with acid reflux, distinct from other reflux patients.
Börjesson
M
M
Multidisciplinary Pain Center, Department of Internal Medicine, Sahlgrenska University Hospital/Ostra, Göteborg, Sweden. mats.borjesson@med-fak.gu.se
Pilhall
M
M
Rolny
P
P
Mannheimer
C
C
D002637:Chest Pain / Q000209:etiology; D015154:Esophageal Motility Disorders / Q000150:complications* / Q000503:physiopathology; D004943:Esophagogastric Junction / Q000503:physiopathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology* / Q000503:physiopathology; D005773:Gastroscopy; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011312:Pressure