Diagnosis of nutcracker esophagus, segmental or diffuse hypertensive patterns, and clinical characteristics.

Different criteria have been used for the diagnosis of nutcracker esophagus, but the clinical importance of this is largely unknown. To this end, 45 patients with hypertensive esophageal peristalsis were identified from 572 esophageal investigations, and thereafter explored with regard to diagnostic criteria and clinical background data. The numbers of patients classified as having nutcracker esophagus with different criteria were 25 (by Richter criteria), 39 (by Achem criteria), and 45 (by Gothenburg criteria). In comparison with patients with segmental hypertensive peristalsis, patients with diffuse hypertensive peristalsis were more often referred for chest pain (P < 0.05), less often for reflux symptoms (P < 0.05), and tended to have arterial hypertension less often (P < 0.08). In conclusion, the choice of criteria for the diagnosis of nutcracker hypertensive peristalsis has prominent effects on the number of patients receiving this diagnosis. Moreover, a diffuse nutcracker peristaltic pattern appears more strongly linked to chest pain.