title: Low esophageal mucosal blood flow in patients with nutcracker esophagus.
abstract: Nutcracker esophagus (NE) is characterized by high-amplitude peristaltic esophageal contractions, and these patients often present with symptoms of "angina-like" or noncardiac chest pain. Tissue ischemia is a known cause of visceral pain, and the goal of our present study was to determine whether esophageal wall blood perfusion (EWBP) is reduced in patients with NE. Fourteen normal subjects (mean age 51 yr, 11 men) and 12 patients (mean age 53 yr, 9 men) with NE and noncardiac chest pain were investigated. The EWBP was measured continuously using a custom-designed laser Doppler probe tethered to a Bravo capsule, which anchored it to the esophageal wall. The baseline EWBP in normal subjects was 651 ± 27 perfusion units. In patients with NE, the baseline EWBP was significantly lower than in the normal subjects (451 ± 32 perfusion units). The EWBP decreased after injection of edrophonium (which increases muscle contractions) and increased following sublingual nitroglycerin administration (which relaxes muscle) in normal subjects, as well as in NE patients. Spontaneous pain events during the recording period were often associated with drops in the EWBP. We propose that low EWBP leads to hypoxia of the esophageal tissue, which may be a mechanism of esophageal pain in patients with NE.
authors.affiliation: Department of Medicine, Division of Gastroenterology, San Diego Veterans Affairs Health Care System, and University of California, San Diego, California.
authors.forename: Yanfen
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Department of Medicine, Division of Gastroenterology, San Diego Veterans Affairs Health Care System, and University of California, San Diego, California rmittal@ucsd.edu.
authors.forename: Ravinder K
authors.initials: RK
authors.lastname: Mittal
mesh_terms: D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000209:etiology; D015154:Esophageal Motility Disorders / Q000503:physiopathology*; D004947:Esophagus / Q000098:blood supply* / Q000187:drug effects; D005260:Female; D006801:Humans; D007511:Ischemia / Q000503:physiopathology; D017078:Laser-Doppler Flowmetry; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000098:blood supply / Q000187:drug effects; D009119:Muscle Contraction / Q000187:drug effects; D005996:Nitroglycerin / Q000494:pharmacology; D012039:Regional Blood Flow / Q000187:drug effects; D014665:Vasodilator Agents / Q000494:pharmacology
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin
keywords: esophageal pain; esophageal wall blood perfusion; ischemia-perfusion injury; noncardiac chest pain