Esophagus is a hollow muscular tube. Its main function is to propel food and fluid that it receives from mouth into the stomach. This function is possible due to sequential contraction of the esophageal muscles with timed relaxation of the two sphincters, namely the upper esophageal sphincter (UES) and lower esophageal sphincter (LES). Nutcracker esophagus is a motility disorder of esophagus. Normally when you swallow, the esophagus contract and help the food to move forward. But in nutcracker esophagus, the contractions are severe and strong leading to pain in chest and difficulty in swallowing.The symptoms are usually produced when you swallow food of fluid. In this disorder, the food does not regurgitate out. Dietary changes and medications help to reduce the severity of symptoms in majority of cases suffering from nutcracker esophagus.
Nutcracker Esophagus Causes:
Nutcracker esophagus is a rare motility disorder of esophagus. The disease has derived its name because the pressure exerted during contraction of esophagus muscles is similar to that of mechanical nutcracker. It is more than 180 mm of HG in distal part of esophagus. The disease is also called hypercontractile esophagus.The actual cause of spasm or strong contraction of esophagus is not known. Some experts believe the disease occurs due to abnormality in the neurotransmitters innervating the distal part of esophagus. Few others believe it is caused due to abnormal level of nitric oxide which leads to reflux. Often the symptoms are produced while eating certain food such. For example too hot or cold food may trigger strong spasm in this condition. The disease is usually observed in people more than 50 or 60 years of age. It is more common in females as compared to males. The risk increases if you are suffering from heartburn and gastroesophageal reflux disease (GERD).
Symptoms of Nutcracker Esophagus:
Nutcracker esophagus is characterized as esophageal motility disorder. It means it is disease of abnormal peristalsis of esophagus. Patients suffering from this condition have two key symptoms; pain in chest while swallowing food. This pain is non cardiac in origin, but due to its severity often the pain is misinterpreted to be of cardiac origin. The second common symptom is difficulty in swallowing (dysphagia). The symptoms usually develop when a person eat or drinks. Pain can last for several minutes or hours after ingestion. Chest pain can also occur intermittently. Sometimes patient can also complain of cough and heartburn. In case of nutcracker esophagus there is no regurgitation of food.
Diagnosis of Nutcracker Esophagus:
Physical examination, medical history, age, and certain diagnostic tests help to confirm the diagnosis of esophageal motility disorder like nutcracker esophagus. If the doctor suspects the condition to be nutcracker esophagus from history and physical symptoms, he will recommend certain tests. These tests are X-ray Barium swallow, esophageal manometry, endoscopic ultra sound, etc. Esophageal manometry is a special test which helps to measure the pressure during the peristalsis of esophagus.
Diet and Treatment:
There is no sure shot cure for nutcracker esophagus. Diet can play key role in reducing symptoms such as pain and dysphagia. Here are some simple dietary tips for patients suffering from this disease.
- Your food portion must be small in quantity. This will allow smooth passage of food without causing dysphagia. Patient must include semisolid and fluid more in his diet. He must drink small sips of fluid.
- Avoid eating spicy and oily food.
- Avoid eating heavy meals. Instead divide your meal into small amount but eat frequently. You can eat five or six meals divided at equal interval all through the day.
- Avoid food that is too hot or too cold. Both are known to trigger strong spasm in this patient.
- Avoid fermented foods because it may produce gasses and distention that can give rise to dysphagia.
Nutcracker esophagus is a benign condition. Treatment is focused on alleviating pain and difficulty in swallowing the two key symptoms. Since the condition is incurable, medication is used to reduce severity of symptoms so that person feels comfortable while eating and drinking. Proton pump inhibitor, calcium channel blockers, anticholinergic medications, etc are used to alleviate symptoms. Relaxation techniques such as yoga and meditation are also beneficial to relieve symptoms in a long run. In some cases, patient may need balloon dilatation of the distal part of the esophagus.