title: [Reflux-associated nutcracker oesophagus in a 49-year-old patient with non-cardiac chest pain (NCCP)].
abstract: A 49-year-old woman was admitted to our department because of intermittent left-sided chest pain for the past 2 years. The patient reported an increasing frequency and duration of the symptoms which were independent from food intake, medication or physical exercises. A cardiac cause of the chest pain was excluded before admittance to our hospital. The initially performed upper endoscopy revealed a small oesophageal hiatal hernia but no signs of acute or chronic inflammation. Basal oesophageal manometry and pH monitoring confirmed the presence of a nutcracker oesophagus, defined by high-amplitude contractions of the distal oesophagus, in combination with a gastro-oesophageal reflux disease. The patient was treated with high-dose pantoprazole for 8 weeks before re-examination. Interestingly, the symptoms completely disappeared upon medication and the relief of the chest pain was accompanied by normalisation of the nutcracker oesophagus pattern. Thus, our observation provides evidence for a causative role of acid reflux in the pathophysiology of the nutcracker oesophagus and, in addition, suggests that effective acid suppression might be a useful therapeutic tool to deal with this painful motility disorder of the oesophagus.
authors.affiliation: Innere Medizin 1, Universitätsklinikum Ulm, Robert-Koch-Strasse 8, 89070 Ulm. steffen.kunsch@web.de
authors.forename: S
authors.initials: S
authors.lastname: Kunsch
authors.forename: U
authors.initials: U
authors.lastname: Spaniol
authors.forename: H
authors.initials: H
authors.lastname: Fensterer
authors.forename: V
authors.initials: V
authors.lastname: Kaechele
authors.forename: G
authors.initials: G
authors.lastname: Adler
authors.forename: V
authors.initials: V
authors.lastname: Ellenrieder
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D002637:Chest Pain / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D015154:Esophageal Motility Disorders / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D000077402:Pantoprazole; D016896:Treatment Outcome
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D000077402:Pantoprazole