The most common primary esophageal motility disorder is:
|B||Segmental esophageal spasm|
|C||Diffuse esophageal spasm|
|D||Nut cracker esophagus|
a. Nutcracker esophagus is a disorder of the movement of the esophagus, and is one of many motility disorders of the esophagus, including achalasia and diffuse esophageal spasm.
b. It is the most common of the primary esophageal motility disorders, it is a manometric abnormality in patients with chest pain characterized by peristaltic esophageal contraction with peak amplitudes greater than two standard deviations above normal values.
c. Contraction amplitude in these patient can easily by above 400 mmHg.
d. It causes difficulty swallowing, or dysphagia, to both solid and liquid foods, and can cause chest pain.
e. it may also be asymptomatic.
f. Nutcracker esophagus can affect people of any age, but is more common in the 6th and 7th decades of life.
g. The diagnosis is made by an esophageal motility study (esophageal manometry), which evaluates the pressure of the esophagus at various points along its length.
h. The term "nutcracker esophagus" comes from the finding of increased pressures during peristalsis, with a diagnosis made when pressures exceed 180 mmHg; this has been likened to the pressure of a mechanical nutcracker.
i. In patients who have dysphagia, testing may first be done to exclude an anatomical cause of dysphagia, where there is a distortion of the anatomy of the esophagus.
j. This usually includes visualization of the esophagus with an endoscope, and can also include barium swallow x-rays of the esophagus.
k. Endoscopy is typically normal in patients with nutcracker esophagus; however, abnormalities associated with gastroesophageal reflux disease, or GERD, which associates with nutcracker esophagus, may be seen.