Gastroesophageal acid reflux in patients with nutcracker esophagus

Background: Hypertensive esophageal contraction, called nutcracker esophagu s (NE), is the most common motility abnormality associated with cardiac-lik e chest pain. However, its significance for the development of symptoms has been a matter of controversy for decades, and recently it has been suggest ed that NE might represent a primarily acid-related esophageal disorder. Th e frequency of acid-related esophageal dysfunction is studied in an unselec ted group of patients with NE. Methods: During the period March 1993 to Jun e 1998, 572 consecutive patients underwent esophageal manometry and 24-h pH monitoring. Results: A motility pattern consistent with NE was found in 45 subjects referred because of chest pain (n = 35), reflux dyspepsia only (n = 8) or epigastric pain (n = 2). Acid-related esophageal dysfunction was n oted in 30 (70%) of the NE patients; abnormal acid exposure time (n = 21), esophagitis (n = 2) or positive symptom index (n = 7). In addition, an incr eased number of reflux episodes were found in another three subjects. NE wa s more prevalent in subjects referred for chest pain than in those referred for other symptoms (14.3% versus 4.5%; P < 0.0001) and, conversely, 78% of the patients with NE were referred because of chest pain. Conclusions: Var ious aspects of acid-related esophageal dysfunction occur frequently in pat ients with NE, suggesting that acid may play a role in the development of s ymptoms in NE. Nonetheless, given its association with chest pain, NE could be a marker of a subgroup of patients with acid reflux, distinct from othe r reflux patients.