title: Distal esophageal hypercontractility is related to abnormal acid exposure.
abstract: OBJECTIVE
  Nutcracker esophagus (NE) is a frequent primary motility disorder of the distal esophagus, and the relationship with acid exposure remains controversial. We studied simultaneous distal esophageal hypercontractility (EH) using two sensors at 8 and 3 cm above the lower sphincter (LES) and abnormal exposure to acid (pH DeMeester score).
  
  
  METHODS
  From 400 screened patients with chest pain and heartburn, 54 (age 44.5 ± 8.8 years and 74% females) had abnormal manometry and underwent acid exposure measurement. Frequencies of the EH disorder were classic NE (EH(3 cm)) found in 29 (40.8%) patients, diffuse (EH(3,8 cm)) in 30 patients (42.3%), and upper segmental (EH(8 cm)) in 12 patients (16.9%).
  
  
  RESULTS
  We found a positive correlation among age with high amplitude in EH(3 cm) and EH(3,8 cm). DeMeester's score (DMS) had the lowest value for EH(3,8 cm) (2.58 ± 0.23) compared with EH(8 cm) (3.78 ± 0.3, p <0.003) and EH(3 cm) (3.12 ± 0.2, p <0.06). Surface response for joint effect of age and DMS on amplitude at EH(3 cm) confirmed the highest amplitude was for older age and lower DMS.
  
  
  CONCLUSIONS
  EH(3 cm) and EH(3,8 cm) were common for esophageal motility and were inversely associated with DMS. Meanwhile, acid exposure was higher in younger patients and hypercontractility was more frequent in older subjects. The former group may benefit more from proton pump inhibitors and the latter from visceral analgesics or possibly both.
authors.affiliation: Clínica de Fisiología Digestiva del Hospital Metropolitano y Hospital de Alta Especialidad PEMEX SUR, Mexico, D.F., Mexico.
authors.forename: Julio César
authors.initials: JC
authors.lastname: Soto-Pérez
authors.forename: Sergio
authors.initials: S
authors.lastname: Sobrino-Cossío
authors.forename: Paul B
authors.initials: PB
authors.lastname: Higgins
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Comuzzie
authors.forename: Jose Antonio
authors.initials: JA
authors.lastname: Vargas Romero
authors.forename: Arturo
authors.initials: A
authors.lastname: Reding-Bernal
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: López-Alvarenga
mesh_terms: D000328:Adult; D000367:Age Factors; D015154:Esophageal Motility Disorders / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011312:Pressure