Hypertensive peristalsis in the pathogenesis of chest pain: further exploration of the "nutcracker" esophagus.

The recently described "nutcracker esophagus" is associated with hypertensive peristaltic contractions and clinical complaints of chest pain and/or dysphagia. This report describes our experience with a group of 28 patients meeting the manometric and clinical criteria for this esophageal motor disorder, and it includes a specific comparison of contractions in the proximal and distal esophagus. Mean lower esophageal sphincter pressure, peak peristaltic pressures, mean peristaltic pressures, and contraction durations were all significantly elevated in the patient group. Using similarly radially oriented transducers, the amplitudes of peristaltic contractions in the distal esophagus were shown to be significantly greater in the patients than in an asymptomatic control group. No significant peristaltic differences were found between patients and controls in the proximal esophagus. These data support the existence of nutcracker esophagus as an identifiable esophageal motor disorder with several specific divergences from esophageal peristaltic parameters in controls.