Nutcracker esophagus is a type of a motility disorder of the esophagus. While this disorder can affect individuals of any age group, it is more frequent among elderly individuals in the age group of 60 to 70 years. In general this disorder is self-limiting and doesn’t progress and hence the focus of treatment is to aim at controlling the symptoms associated with the condition.
This disorder is referred to as ‘Nutcracker esophagus’ since an assessment of pressure in the esophagus at different points during the process of peristalsis matches with the pressure of a mechanical nutcracker, which exceeds 180mmHg.
There are two key symptoms that are associated with this motility disorder which include chest pain (which is of non-cardiac origin) and dysphagia (difficulty in swallowing food). These symptoms are usually intermittent and may occur during the consumption of food or otherwise.
Rarely is this condition associated with sudden obstruction, which may eventually require urgent hospitalization and treatment. Fortunately this condition is not associated with other anatomical abnormalities including strictures or esophageal cancer.
What Are The Causes Of Nutcracker Esophagus?
The cause associated with nutcracker esophagus is not known.
In patients suffering from dysphagia, barium swallow studies are conducted in order to identify any anatomical disorders within the esophagus. Barium swallow studies are followed with an endoscopic examination of the walls of the esophagus, however in most cases, endoscopy study findings are usually normal.
Esophageal motility studies are most important in nutcracker esophagus. Esophageal motility study measures the pressure across the esophagus, during the movement of food through the esophagus. There are two criterion for diagnosis of this condition, firstly the mean amplitude at the distal part of the esophagus should be more than 180 mmHg and secondly there should be two consecutive contractions which should last for a duration of more than six seconds.
Diet And Treatment For Nutcracker Esophagus
While there is no real cure for this condition and hence dietary correction plays a vital role in alleviating the symptoms of pain and dysphagia. Here are some important tips,
- The major component of the diet should comprise of fluids and soft foods. Eat very small quantities of food, take small sips of fluid. Large bolus of food can trigger an episode of dysphagia.
- Avoid oily, spicy and starchy foods and also meat. Trans fats should be completely avoided.
- Eat small quantities of food frequently during the day. Don’t have a heavy meal; instead divide your routine into six small meals through the day.
- Consume fresh fruits or fruit juices only in the morning, since fruits tend to ferment when they mix with other types of food and cause gaseous distension, which can trigger dysphagia.
- Avoid fermented foods or high fiber diet, as they can also contribute to distention and cause dysphagia.
Nutcracker Esophagus Treatment
Since this condition is not associated with any complications the focus of the treatment is to minimize the severity of the symptoms. This condition can’t be cured but there are certain medications that might be useful in alleviating the symptoms. Occasionally dilation of the distal part of the esophagus with endoscopic balloons is also a tested and proved treatment option.