What is the pathophysiology of nutcracker and jackhammer esophagus?

Updated: Aug 07, 2019
  • Author: Ahmad Malas, MD; Chief Editor: BS Anand, MD  more...
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Answer

Nutcracker and jackhammer esophagus occur when the amplitude of the contractions exceed 2 standard deviations from normal. The contractions proceed in an organized manner, propelling food down the esophagus. These patients present with chest pain more often than they present with dysphagia, as they experience less dysphagia than patients with diffuse esophageal spasm.

Because the progression of the contractions occurs normally, patients often do not benefit from a myotomy. Even though the increased amplitude of the contractions can be demonstrated using manometry, the symptoms often do not correlate with the manometrically documented contractions.

The symptoms of diffuse esophageal spasm, nutcracker esophagus, and jackhammer esophagus may overlap and can be distinguished only by a motility study.


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