Nutcracker oesophagus: a double-blind, placebo-controlled, cross-over study of the effects of lansoprazole.
BACKGROUND
Nutcracker oesophagus is characterized by high-amplitude oesophageal contractions. Recent data have shown a high prevalence of gastro-oesophageal acid reflux in patients with nutcracker oesophagus and, in open-label trials, patients seemed to benefit from acid suppression. Therefore, it has been suggested that non-cardiac chest pain in patients with nutcracker oesophagus may be related to reflux rather than to the motor abnormality itself.


OBJECTIVE
To investigate the effect of intensive acid-suppressive treatment on chest pain in patients with nutcracker oesophagus.


METHODS
Nineteen patients with nutcracker oesophagus received lansoprazole or placebo in a double-blind, randomized, cross-over study.


RESULTS
Significant reductions in pain intensity (P < 0.006) and pain duration (P < 0.05) were registered during the study. The magnitude of symptom relief achieved with lansoprazole did not differ significantly from that achieved with placebo. The motility pattern did not change during the study.


CONCLUSIONS
This study does not prove that acid-suppressive therapy is effective for pain relief in nutcracker oesophagus. As the amelioration of pain was not accompanied by any change in the nutcracker oesophagus pattern, it is unlikely that the high-amplitude oesophageal contractions are the cause of pain. Thus, the possible role of acid in the pathophysiology of pain in nutcracker oesophagus needs further study.
Borjesson
M
M
Multidisciplinary Pain Center, Department of Medicine, Sahlgrenska University Hospital/Ostra, Goteborg, Sweden. mats.brjesson@telia.com
Rolny
P
P
Mannheimer
C
C
Pilhall
M
M
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000863:Antacids / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D002637:Chest Pain / Q000188:drug therapy* / Q000503:physiopathology; D018592:Cross-Over Studies; D004311:Double-Blind Method; D015154:Esophageal Motility Disorders / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D064747:Lansoprazole; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009853:Omeprazole / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D010528:Peristalsis / Q000502:physiology; D011446:Prospective Studies
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000863:Antacids; D000897:Anti-Ulcer Agents; D064747:Lansoprazole; D009853:Omeprazole