Nutcracker oesophagus: a double‐blind, placebo‐controlled, cross‐over study of the effects of lansoprazole

Börjesson, Mats; Rolny, P; Mannheimer, Clas; Pilhall, Martin

doi:10.1046/j.1365-2306.2003.01788.x

Cited by 21 publications

(23 citation statements)

References 30 publications

(28 reference statements)

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“…These multipeaked contractions occurred in a context of normal peristaltic amplitude and were converted to single peaked contractions after atropine injection. We also observed instances of Jackhammer Esophagus in GERD patients consistent with prior reports of hypercontractility in patients with reflux disease (4, 28). Relatively few patients in our series had pH monitoring studies done, but about 10% had reflux esophagitis on endoscopy and anti-reflux therapy was also associated with the resolution of symptoms in 8 of 15 patients and normalization of EPT studies in 1 of 2 cases who had follow-up studies.…”

Section: Discussionsupporting

confidence: 91%

Phenotypes and Clinical Context of Hypercontractility in High-Resolution Esophageal Pressure Topography (EPT)

Roman

Pandolfino

Chen³

et al. 2012

American Journal of Gastroenterology

156

199

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Backgrounds & Aims This study aimed to refine the criteria for esophageal hypercontractility in high resolution esophageal pressure topography (EPT) and examine the clinical context in which it occurs. Subjects & Methods 72 control subjects were used to define the threshold for hypercontractility as a distal contractile integral (DCI) greater than observed in normals. 2,000 consecutive EPT studies were reviewed to find patients exceeding this threshold. Concomitant EPT and clinical variables were explored. Results The greatest DCI value observed in any swallow among the control subjects was 7,732 mmHg-s-cm; the threshold for hypercontractility was established as a swallow with DCI >8,000 mmHg-s-cm. 44 patients were identified with a median maximal DCI of 11,077 mmHg-s-cm, all with normal contractile propagation and normal distal contractile latency, thereby excluding achalasia and distal esophageal spasm. Hypercontractility was associated with multipeaked contractions in 82% of instances leading to the name Jackhammer Esophagus . Dysphagia was the dominant symptom although subsets of patients had hypercontractility in the context of EGJ outflow obstruction, reflux disease, or as an apparent primary motility disorder. Conclusion We describe an extreme phenotype of hypercontractility characterized in EPT by the occurrence of at least a single contraction with DCI > 8,000 mmHg-s-cm, a value not encountered in control subjects. This phenomenon, branded Jackhammer Esophagus was usually accompanied by dysphagia and occurred both in association with other esophageal pathology (EGJ outflow obstruction, reflux disease) or as an isolated motility disturbance. Further studies are required to define the pathophysiology and treatment of this disorder.

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Section: Discussionsupporting

confidence: 91%

Phenotypes and Clinical Context of Hypercontractility in High-Resolution Esophageal Pressure Topography (EPT)

Roman

Pandolfino

Chen³

et al. 2012

American Journal of Gastroenterology

156

199

View full text Add to dashboard Cite

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“…Uncontrolled surgical trials tend to show an improvement in reflux symptoms but no change in dysphagia or chest pain [18,20]. As a result, physicians commonly prescribe acid suppression therapy to such patients, although the results of the only randomized controlled trial of a proton pump inhibitor showed no benefit over placebo [21]. This is not inconsistent with our study in which only a minority found acid suppression helpful.…”

Section: Discussioncontrasting

confidence: 47%

A Questionnaire Study to Assess Long-Term Outcome in Patients with Abnormal Esophageal Manometry

2006

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Patients with unexplained chest pain or dysphagia are often referred for esophageal manometric studies to further investigate their symptoms. Four main manometric abnormalities have been described: achalasia, diffuse esophageal spasm, "nutcracker" (hypercontracting) esophagus, and hypocontracting esophagus. With the exception of achalasia, treatments are of limited benefit and the natural history of these conditions is largely unknown. We sent questionnaires to patients who were investigated at least three years before our study began. They repeated a DeMeester symptom questionnaire that they had completed at the time of their initial study. Questionnaires were sent to 137 patients with diffuse esophageal spasm, "nutcracker" (hypercontracting) esophagus, or hypocontracting esophagus. We also sent questionnaires to 57 patients with dysphagia or chest pain who had had normal esophageal manometry and pH studies. These patients acted as symptomatic controls. Responses were compared using the Wilcoxon signed ranks test. Seventy-two (53%) patients with diffuse esophageal spasm, "nutcracker" esophagus, or hypocontracting esophagus replied. An additional 8 (6%) patients died. Symptom scores in all three conditions had improved significantly over time (p < or = 0.01 for each condition, Wilcoxon signed ranks test). Patients with dysphagia or chest pain but normal esophageal studies had not improved. The significance of diffuse esophageal spasm, "nutcracker" esophagus, and hypocontracting esophagus found at esophageal manometry remains uncertain. Although treatment is often ineffective, these conditions typically run a benign course. Patients can be reassured that their symptoms are likely to improve with time.

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“…Some authors observed an improvement in pain with antireflux therapy [37], while others did not obtain similar results [38]. In view of the retrospective nature of our study, we do not have additional information on this particular subject.…”

Section: Discussionmentioning

confidence: 65%

Are There Any Differences Between Nutcracker Esophagus With and Without Reflux?

Silva

Lemme

2007

Dysphagia

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"Nutcracker esophagus" (NE) is a primary esophageal motor disorder, first described in patients with noncardiac chest pain. In recent years NE has been associated with gastroesophageal reflux disease (GERD). In this study we compare patients with NE with and without GERD, as defined by pHmetry or endoscopy, with respect to clinical, endoscopic, radiologic, and manometric findings. Fifty-two patients with NE were studied. They were divided in two groups: GERD (17-32.6%) and non-GERD (35-67.4%) patients. Females predominated in both groups, with no significant difference in age (p>0.05). Chest pain was the chief complaint in both groups (p>0.05). Clinical findings in patients with and without reflux included chest pain (52.9% and 51.4%), dysphagia (58.8% and 42.8%), and heartburn (64.7% and 42.8%), followed by regurgitation, dyspepsia, ear, nose, and throat (ENT) complaints, respiratory symptoms, and odynophagia (p>0.05). Erosive esophagitis was found in three patients (5.7%). There were no differences between groups in the findings of barium swallow studies and all manometric findings were similar for both groups (p>0.05). We conclude that there were no differences in patients with NE with or without associated reflux disease. It is important to diagnose reflux properly so patients can be treated adequately.

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Nutcracker oesophagus: a double‐blind, placebo‐controlled, cross‐over study of the effects of lansoprazole

Cited by 21 publications

References 30 publications

Phenotypes and Clinical Context of Hypercontractility in High-Resolution Esophageal Pressure Topography (EPT)

Phenotypes and Clinical Context of Hypercontractility in High-Resolution Esophageal Pressure Topography (EPT)

A Questionnaire Study to Assess Long-Term Outcome in Patients with Abnormal Esophageal Manometry

Are There Any Differences Between Nutcracker Esophagus With and Without Reflux?

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