Prolonged radionuclide transit in "nutcracker esophagus".

Symptomatic patients with abnormal esophageal manometry characterized by esophageal peristaltic waves of increased amplitude ("the nutcracker esophagus," NE) have been recognized with increasing frequency. Whether or not this represents a true functional abnormality is unresolved at this time. We have utilized radionuclide transit (RT), a true esophageal function test, to evaluate patients with NE. Eighteen consecutive symptomatic patients with the NE and ten clinically and manometrically normal subjects constituted this study group. RT in normals were 6.8 +/- 0.2 sec (means +/- SE) and 27.6 +/- 3.8 in patients with NE. RT was abnormal in 17/18 patients with NE. Chaotic bolus transit was seen in 11/18 patients with NE but not in normals. The defect was localized to the distal esophagus since transit through the proximal esophagus was not significantly different between the two groups. This defect in RT may be related to spontaneous simultaneous contractions seen in 50% of these patients. Further work will be necessary to determine if NE is a true functional abnormality or a marker for other motility abnormalities such as diffuse esophageal spasm.