Nutcracker oesophagus: association with chest pain and dysphagia controlling for gastro-oesophageal reflux.
BACKGROUND
The association between nutcracker oesophagus, gastro-oesophageal reflux and their symptoms is controversial.


OBJECTIVE
To evaluate the association of nutcracker oesophagus with chest pain and dysphagia controlling for gastro-oesophageal reflux.


METHODS
From a database of 935 consecutive patients investigated with oesophageal manometry and pH-metry, we selected all patients with nutcracker oesophagus including diffuse and segmental patterns. Patients with normal oesophageal peristalsis served as controls. Symptoms assessment, manometry testing and 24h oesophageal pH monitoring off acid-suppressive medications were performed following a standardized protocol. The associations between nutcracker oesophagus and symptoms were assessed by logistic regression analysis.


RESULTS
Nutcracker oesophagus was found in 60 patients (6.4%), of which 30 had diffuse nutcracker oesophagus and 30 had segmental nutcracker oesophagus. The control group was composed by 656 patients with normal oesophageal peristalsis. Diffuse nutcracker oesophagus was associated with chest pain (odds ratio 4.3; 95% CI 1.9-9.9; P<0.0001) and dysphagia (odds ratio 5.3; 95% CI 2.3-12.2; P<0.0001), whereas segmental nutcracker oesophagus was associated with chest pain (odds ratio 2.8; 95% CI 1.1-6.9; P=0.026), controlling for total oesophageal acid exposure, age, sex and lower oesophageal sphincter (LOS) pressure.


CONCLUSIONS
This study suggests that both diffuse and segmental nutcracker oesophagus should be regarded as meaningful abnormalities and not mere manometric curiosities.
Fornari
F
F
Laboratory of Esophageal Motility, ENDOPASSO, Passo Fundo/RS, Brazil. fernandofornari@gmail.com
Farré
R
R
van Malenstein
H
H
Blondeau
K
K
Callegari-Jacques
S M
SM
Barros
S G S
SG
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002637:Chest Pain / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D003680:Deglutition Disorders / Q000175:diagnosis / Q000453:epidemiology*; D015154:Esophageal Motility Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000503:physiopathology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D015994:Incidence; D008297:Male; D008365:Manometry; D008875:Middle Aged; D015999:Multivariate Analysis; D011336:Probability; D011379:Prognosis; D012016:Reference Values; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index