Abnormal Passage of Radionuclide Liquid Bolus through Distal Esophagus and Lowar Esophageal Sphincter in Patients with Nutcracker Esophagus

Yoon, Chong Mann; Rew, Jong Sun; Bom, Hee Seung; Choi, Sung Kyu; Oh, Won Tae; Cho, Cheon Yeong; Lee, Wan Sik; Park, Chang Hwan

Abstract

BACKGROUND AND AIMS: The nutcraeker esophagus is characterized manometrically by peristaltic waves of abnormally high amplitude exceeding 180 mmHg in the distal esophagus. It has been known as one of the most frequent esophageal motor disorder causing noncardiac chest pain and dysphagia. But there is a controversy on the food passage through the esophagus of patients with nutcracker esophagus. We performed this study to evaluate the food passage disturbance through the distal esophagus and lower esophageal sphincter (LES) in patients with nutcracker esophagus.
METHODS
We examined 26 consecutive patients with nutcracker esophagus and 20 age-sex matched volunteers by means of both esophageal mamometry and radionuclide esophageal transit study on the same day. Esophageal manometry was performed with pneumohydraulically perfused catheters attached to transducer. A station pull-through technique was employed to record peristaltic amplitude and duration. The pressure and relaxation percentage of LES were measured after 3 times wet swallows. Radionuclide esopbageal transit study included distal esophageal transit time, the presence of to and fro movement, and the time-activity curve of LES.
RESULTS
Patients with nutcracker esophagus showed significantly higher values in amplitude and duration of peristaltic contractions, and LES pressure as compared with those of the normal volunteers (236.2 +/-47.5 mmHg, 5.5+1.4 sec, 31.2+8.1 mmHg vs 92.0+11.5 mmHg, 3.5+/-1.2 sec, 22.3+/-4.7 mmHg, respectiveiy) (p<0.01). Distal esophageal transit time was significantly longer in patients with nutcracker esophagus (12.7+/-7.0 see) than that of the normal volunteers (5.6+/-1.0 sec)(p<0.01). To and fro movement was found in 50% (13/26) of nutcracker esophagus group, but not in the nomal volunteers. Broad transit curves of LES were more frequent in patients with nutcracker esophagus (88%, 23/26) than in normal volunteers (45%, 9/20)(p<0.05).
CONCLUSIONS
These findings suggest that the pathology of nutcracker esophagus might include other disturbances besides elevated distal amplitude. Thus, other parameters should also be studied in the evaluation of new therapeutic modalities.