Nutcracker esophagus

1985 ◽  
Vol 30 (2) ◽  
pp. 188-188 ◽  
Author(s):  
Joel E. Richter ◽  
Wallace C. Wu ◽  
Robert J. Cowan ◽  
David J. Ott ◽  
John N. Blackwell
Keyword(s):  
Nutcracker Esophagus

Psychological comparison of patients with nutcracker esophagus and irritable bowel syndrome

1986 ◽  
Vol 31 (2) ◽  
pp. 131-138 ◽  
Author(s):  
Joel E. Richter ◽  
W. Fred Obrecht ◽  
Laurence A. Bradley ◽  
Larry D. Young ◽  
Karen O. Anderson
Keyword(s):  
Irritable Bowel Syndrome ◽  
Nutcracker Esophagus ◽  
Irritable Bowel

(078). Nutcracker esophagus and gastro-esophageal reflux association

2009 ◽  
Vol 10 (2) ◽  
pp. AB38
Author(s):  
R. Goubraim ◽  
I. Serraj ◽  
L. Amrani ◽  
M. Nya ◽  
N. Amrani
Keyword(s):  
Esophageal Reflux ◽  
Nutcracker Esophagus

Topography of normal and high-amplitude esophageal peristalsis

1993 ◽  
Vol 265 (6) ◽  
pp. G1098-G1107 ◽  
Author(s):  
R. E. Clouse ◽  
A. Staiano
Keyword(s):  
Skeletal Muscle ◽  
Smooth Muscle ◽  
Distal Segment ◽  
High Amplitude ◽  
Nutcracker Esophagus ◽  
Topographic Analysis ◽  
Esophageal Body ◽  
Peristaltic Contraction ◽  
Asymptomatic Volunteers ◽  
Contour Plots

Topographic plots were created from esophageal manometric tracings in 12 asymptomatic volunteers and 10 symptomatic patients with high-amplitude peristaltic contraction waves (nutcracker esophagus) to identify segmental contraction differences between the two groups. Median waves at each centimeter of esophageal length were spatially interconnected using a computerized gridding and plotting system, and a characteristic peristaltic contraction from the proximal esophageal body through the lower sphincter was constructed for each subject. Contour plots in the volunteers revealed three amplitude troughs dividing the peristaltic contraction into four sequential segments: the skeletal muscle body, the proximal and distal segments of the smooth muscle body, and the lower sphincter region. In nutcracker-esophagus patients, only the first and third troughs could be identified, since augmented contraction in the distal smooth muscle segment blurred separation of the smooth muscle body segments. Volume measurements under the topographic plots showed no significant intergroup differences in contraction of the skeletal muscle region or lower sphincter but modest increase in contraction of the proximal smooth muscle segment [1.7 times normal, 95% confidence interval (CI) 1.2-2.0; P = 0.002 comparing 2 groups] and marked increase in the distal smooth muscle segment (2.7 times normal, 95% CI 2.0-3.3; P < 0.0001). These data indicate that normal peristalsis through the esophageal body and lower sphincter includes four separate contraction segments that can be distinguished with intraluminal manometry and the topographic analysis method. The nutcracker esophagus primarily affects the distal segment in the smooth muscle body.

scholarly journals Esophageal Manometry with Provocative Testing in Patients with Noncardiac Angina-Like Chest Pain

1991 ◽  
Vol 5 (2) ◽  
pp. 51-57 ◽  
Author(s):  
William G Paterson ◽  
Delia A Marciano-D’Amore ◽  
Ivan T Beck ◽  
Laurington R Da Costa
Keyword(s):  
Chest Pain ◽  
Esophageal Motility ◽  
Esophageal Manometry ◽  
Motility Disorder ◽  
Diffuse Esophageal Spasm ◽  
Esophageal Motility Disorder ◽  
Nutcracker Esophagus ◽  
Hypertensive Lower Esophageal Sphincter ◽  
Acid Perfusion ◽  
Provocative Testing

In a five year period 238 of 594 esophageal manometric studies performed in the authors’ laboratory were done on patients whose major reason for referral was noncardiac angina-like chest pain. Standard eophageal manometry was performed followed by an acid-antacid perfusion period (Bernstein test) and then subcutaneous bethanechol (80 μg/kg to a maximum of 5 mg) was adminstered. Baseline manometry was normal in 38% of patients and was diagnostic of ‘nutcracker’ esophagus, nonspecific esophageal motility disorder, diffuse esophageal spasm and isolated hypertensive lower esophageal sphincter in 24%, 19%, 16% and 3% of patients, respectively. Ninety-six of 238 patients (40%) experienced reproduction of their presenting angina-like chest pain during acid perfusion. In 80% of these patients there were associated esophageal motor abnormal ilies induced by the acid perfusion. Thirty-six of 212 (17%) experienced pain reproduction following the injection of bethanechol; however, 16 of these had already had their presenting chest pain reproduced during the acid perfusion study. In two-thirds of the patients with pain reproduction following bechanechol there was an associated bethanechol-induced esophageal motility disorder. Overall 49% of patients had their pain reproduced during provocative testing. The acid perfusion test reproduced the pain much more frequently than bethanechol simulation. This study reaffirms the value of esophageal manometry and provocative testing in this group of patients.

Radiology of the Nutcracker Esophagus

1986 ◽  
Vol 8 (3 Part 1) ◽  
pp. 230-232 ◽  
Author(s):  
Sarkis J. Chobanian ◽  
David J. Curtis ◽  
Stanley B. Benjamin ◽  
Edward L. Cattau
Keyword(s):  
Nutcracker Esophagus

Cholinergic stimulation induces asynchrony between the circular and longitudinal muscle contraction during esophageal peristalsis

2008 ◽  
Vol 294 (3) ◽  
pp. G694-G698 ◽  
Author(s):  
Hariprasad Korsapati ◽  
Arash Babaei ◽  
Valmik Bhargava ◽  
Ravinder K. Mittal
Keyword(s):  
Longitudinal Muscle ◽  
Acetylcholinesterase Inhibitor ◽  
Time Lag ◽  
Control Period ◽  
Temporal Correlation ◽  
Normal Subjects ◽  
Esophageal Peristalsis ◽  
Nutcracker Esophagus ◽  
The Mean ◽  
Mean Time

In healthy subjects, a close temporal correlation exists between contractions of the circular muscle (CM) and longitudinal muscle (LM) layers of the esophagus. Patients with nutcracker esophagus show disassociation between the peak of contractions of the CM and LM layers and the peak of contraction 1–3 s apart (Jung HY, Puckett JL, Bhalla V, Rojas-Feria M, Bhargava V, Liu J, Mittal RK. Gastroenterology 128: 1179–1186, 2005). The purpose of the present study was to evaluate the effect of acetylcholinesterase inhibitor (edrophonium) and acetylcholine receptor antagonist (atropine) on human esophageal peristalsis in normal subjects. High-frequency intraluminal ultrasound imaging and manometry were performed simultaneously during swallow-induced peristalsis in ten normal subjects. Standardized 5-ml water swallows were recorded 2 cm above the lower esophageal sphincter under three study conditions: control, edrophonium (80 μg/kg iv), and atropine (10 μg/kg iv). A close temporal correlation exists between the peak pressure and peak wall thickness during the control period. The mean time lag between the peak LM and peak CM contraction was 0.03 s. After edrophonium administration, the mean contraction amplitude increased from 101 ± 9 mmHg to 150 ± 20 mmHg ( P < 0.05) and mean peak muscle thickness increased from 3.0 ± 0.2 mm to 3.6 ± 0.3 mm ( P < 0.01), and duration of both CM and LM contractions were also increased. Furthermore, the mean time difference between the peak LM and CM was increased to 1.1 s, (ranging 0.2 to 3.4 s) ( P < 0.0001). We conclude that cholinomimetic agent induces discoordination between the two muscle layers of the esophagus.

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