Esôfago em quebra-nozes -- avaliação clínica de 97 pacientes

Abstract

Nutcracker esophagus is a manometric abnormality classified as a primary esophageal motor disorder, characterized by high pressure peristaltic waves in distal esophagus and related to non-cardiac chest pain. Further studies observed nutcracker esophagus in dysphagic patients and recently in gastroesophageal reflux disease. However, there is controversy about the meaning of this motor disorder and there are few clinical studies involving a great number of patients. A retrospective study involving 97 patients with manometric criteria of nutcracker esophagus according a control group was undertaken. Most of the patients were female (63.9%), mean age 54.3 years. The chief complaint was chest pain, followed by dysphagia and heartburn. Clinical findings, as a whole were chest pain (53.6%), dysphagia (52.6%), heartburn (52.6%), regurgitation (21.6%), otorhinolaryngologic symptoms (15.4%), dyspepsia (15.4%) and odynophagia (4.1%). The majority of patients had multiple symptoms, however in 28% just a single one was observed. Endoscopic examination observed erosive esophagitis in 8% of the patients, while signs of esophageal motor disorders were showed by esophagogram in 16.4%. Esophageal pH recordings indicated abnormal gastroesophageal reflux in 41.2% of the cases reported. We concluded that there are other symptoms in nutcracker esophagus patients besides chest pain and dysphagia and the use of esophageal pH recordings is helpful to establish its association with acid reflux and guide the appropriate therapy.

Chest Pain and Alternate Dysphagia

“…Nutcracker is considered as the most common symptoms inclusive chest pain and dysphasia in patients receiving manometry due to unknown causes. 1 The clinical manifestations of nutcracker esophagus included pain in the posterior side of the sternum, dysphagia, heartburn, regurgitation, dyspepsia, cough, and odynophagia 2 symptoms that mainly are inclusive of chest pain and dysphagia. It is also notable that there is a weak correlation between manometric findings and the clinical manifestations such as chest pain and dysphagia.…”

Evolução motora incomum na doença do refluxo gastroesofágico

“…A presença constante do conteúdo gastroduodenal (refluxato) em contato com a mucosa esofágica determina presença de ondas de condução de baixa amplitude e falhas de condução 7 . Apesar do distúrbio motor mais frequentemente associado ser o esôfago em quebra-nozes 13 , essa afecção é dita também (em menor proporção) como possível causa do espasmo esofageano difuso, podendo ser primário ou associado à doença do refluxo gastroesofágico 3 .…”