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J Clin Gastroenterol. 2006 Jul;40(6):504-9.

Clinical relevance of the nutcracker esophagus: suggested revision of criteria for diagnosis.

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  • 1Digestive Diseases Center, Medical University of South Carolina, Charleston, SC 29425, USA. agrawala@musc.edu

Abstract

BACKGROUND:

Nutcracker esophagus (NE) is a manometric finding defined by peristaltic contractions with a mean distal esophageal amplitude (DEA) >180 mm Hg. This threshold has been selected as it exceeds the average DEA in healthy volunteers by 2 SDs. Since its introduction the clinical significance of this finding has been challenged, as many patients with NE are asymptomatic.

AIM:

To evaluate whether defining NE based on a different DEA threshold would be clinically more meaningful.

METHODS:

Retrospective review of prospectively collected manometry data between October 2001 and December 2003. Using previously published normal DEA values (mean and SD) patients with NE were stratified into 3 groups: group A (2 to 3 SD above mean): DEA 180 to 220 mm Hg; group B (3 to 4 SD above mean): DEA 220 to 260 mm Hg; and group C (>4 SD above mean): DEA >260 mm Hg. Symptoms, esophageal acid exposure, bolus transit data, and lower esophageal sphincter data were reviewed.

RESULTS:

The stratification of 56 NE patients into groups A, B, and C were 31, 16, and 9, respectively. The proportion of patients presenting with chest pain increased from 23% in group A to 69% in group B and 100% in group C. Patients in group C had significantly (P<0.05) higher mean lower esophageal sphincter pressure, shorter bolus transit time, and lower frequency of abnormal reflux.

CONCLUSIONS:

A revised definition of NE to include patients with a DEA >260 mm Hg, and possibly those with >220 may have greater clinical relevance.

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PMID:
16825932
[PubMed - indexed for MEDLINE]
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