THE NUTCRACKER ESOPHAGUS - A LATE DIAGNOSTIC YIELD NOTWITHSTANDING CHEST PAIN AND DYSPHAGIA

The nutcracker esophagus, a primary motor disorder, is frequently asso ciated with noncardiac chest pain. However, there are no data on wheth er its diagnosis, as in other esophageal motility disorders, is delaye d. Since the disorder is frequently heralded by alarming symptoms such as chest pain and dysphagia, diagnosis should be made as soon as poss ible. In this study we assessed the diagnostic delay, if any, in patie nts with the nutcracker esophagus. Moreover, we were interested in whe ther the abnormalities described in the distal esophagus could also in volve the entire viscus. Fifty-four subjects (age range 23-78 yr) with the nutcracker esophagus were assessed for clinical and manometric va riables as an overall group and after dividing them into subgroups acc ording to their symptoms. The manometric variables were compared with those obtained in 61 controls (age range 21-67 yr). Overall, a diagnos is of nutcracker esophagus was made after an average period of 36 +/- 6 months, and surprisingly, this was not different in the various subg roups complaining of either chest pain, dysphagia, or both. Analysis o f manometric variables showed that the mean amplitude of contractions was significantly higher in the patients' group at all esophageal body levels, even in the proximal portions. Again, there were no significa nt differences among the subgroups of nutcracker esophagus with respec t to the symptoms. Not withstanding the presence of alarming symptoms, such as chest pain and dysphagia, the nutcracker esophagus is diagnos ed on average after 3 years from the onset of symptoms. Manometric ass essment seems to confirm that this entity may indeed represent a prima ry esophageal motor disorder. The major dysfunction is due to an abnor mal increase of contraction amplitude of the entire esophageal body.