Nutcracker Esophagus

Patient Education

What is nutcracker esophagus?
Nutcracker esophagus is a disorder of the movement of the esophagus (food pipe). Abnormal pressure occurs during the rhythmic contractions that occur when the esophagus transports food to the stomach (called peristalsis). The condition does not progress or cause serious complications, but it may cause discomfort or perceived difficulty swallowing.

What causes nutcracker esophagus?
The exact causes of nutcracker esophagus are unknown. The condition can affect people of all ages but is more common in those over 60.

What are the symptoms of nutcracker esophagus?
Patients with nutcracker esophagus may have heartburn, chest pain or dysphagia (difficulty with swallowing). Nutcracker esophagus can be very uncomfortable and sometimes very painful.

How is nutcracker esophagus diagnosed?
In patients who have dysphagia, testing may first be done to exclude other causes of dysphagia. This usually includes viewing the esophagus with an endoscope.

Manometry (motility study) is used to diagnose for nutcracker esophagus. During the procedure, a thin flexible tube is passed through the nostril, down the back of the throat into the esophagus to measure pressure along the esophagus. If pressure is found to be higher than normal (greater than 180 mmHg), it may confirm the presence of nutcracker esophagus.

How is nutcracker esophagus treated?
Since nutcracker esophagus isn’t associated with any complications and does not get worse, treatment is aimed at controlling symptoms. No real cure is available, but the following can be used to relieve pain and discomfort:
• Medications, including smooth muscle relaxant drugs such as nitroglycerin and calcium channel blockers
• Injection of Botox (Botulinum Toxin Type A) into the muscles of the esophagus to relax them temporarily
• Dilation of the esophagus using special endoscopic balloons

When to seek medical advice:
Contact your doctor if you are frequently experiencing difficulty with swallowing. Call 911 or go to the nearest emergency department if an obstruction causes an inability to swallow or interferes with breathing.