title: High-resolution impedance manometry findings in patients with nutcracker esophagus.
abstract: OBJECTIVE
  The objective of this study was to evaluate the association between high-resolution manometry (HRM) and impedance findings and symptoms in patients with nutcracker esophagus (NE).
  
  
  METHODS
  After institutional review board approval retrospective review of a prospectively maintained database identified patients who were diagnosed with NE as per the Chicago classification (distal contractile integral [DCI] > 5000 mmHg-s-cm) at Creighton University between October 2008 and October 2010. Patients with achalasia or a history of previous foregut surgery were excluded. NE patients were sub-divided into: (i) Segmental (mean distal esophageal amplitude [DEA] at 3 and 8 cm above lower esophageal sphincter [LES] < 180 mmHg) (ii) Diffuse (mean DEA at 3 and 8 cm above LES > 180 mmHg) and (iii) Spastic (DCI > 8000 mmHg-s-cm).
  
  
  RESULTS
  Forty-one patients (segmental: 13, diffuse: 4, spastic: 24) satisfied study criteria. Patients with segmental NE would have been missed by conventional manometry criteria as their DEA < 180 mmHg. A higher percentage of patients with spastic NE (63%) had chest pain when compared to patients with segmental NE (23%) and diffuse NE (25%). There was a significant positive correlation between chest pain severity score and DCI while there was no significant correlation between dysphagia severity and DCI.
  
  
  CONCLUSIONS
  In patients diagnosed with NE using the Chicago classification presence and intensity of chest pain increases with increasing DCI. The present criteria (> 5000 mmHg-s-cm) seems to be too sensitive and has poor symptom correlation. Adjusting the criteria to 8000 mmHg-s-cm is more relevant clinically.
authors.affiliation: Department of Surgery, Creighton University Medical Center, Omaha, NE 68131, USA.
authors.forename: Masato
authors.initials: M
authors.lastname: Hoshino
authors.forename: Abhishek
authors.initials: A
authors.lastname: Sundaram
authors.forename: Arpad
authors.initials: A
authors.lastname: Juhasz
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Yano
authors.forename: Kazuto
authors.initials: K
authors.lastname: Tsuboi
authors.forename: Tommy H
authors.initials: TH
authors.lastname: Lee
authors.forename: Sumeet K
authors.initials: SK
authors.lastname: Mittal
mesh_terms: D000328:Adult; D002637:Chest Pain / Q000150:complications* / Q000503:physiopathology; D015154:Esophageal Motility Disorders / Q000145:classification* / Q000150:complications / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010992:Plethysmography, Impedance; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013997:Time Factors