Frequency of endoscopic esophagitis in nutcracker patients with pathological 24-hour pH monitoring

Endoscopically, it was claimed that reflux esophagitis is less frequently seen in patients with tertiary contractions. The aim of this prospective study is to evaluate the frequency of endoscopic esophagitis in nutcracker patients with pathological 24-hour pH monitoring as compared to a matched group of patients with pathological prolonged ambulatory pH monitoring. The study included eight patients with nutcracker esophagus and pathological 24-hour pH monitoring (Group 1); mean (SD) age was 36.5 (10.6) years, mean (SD) LES pressure was 11 (2.9) mmhg and % total pH < 4 was 11.5 (7), which were not statistically different from a matched control of 25 patients (Group 2). Patients with underlying definable systemic diseases were excluded from the study.. Three nutcracker esophagus and eight control showed evidence of endoscopic esophagitis (P value=0.9). Among group I, nutcracker patients with endoscopic esophagitis had a tendency towards a lower LES pressure (P=0.056) and a significantly greater % total pH < 4 (P=0.04). % upright reflux (P=0.03) and total time pH < 4 (P=0.003) than nutcracker without endoscopic oesophagitis. Moreover, nutcracker patients with endoscopic esophagitis had a significantly greater % total pH < 4 and total time pH < 4 than control group with endoscopic esophagitis with P value = 0.03 and 0.02, respectively.

The frequency of endoscopic esophagitis is similar in nutcracker and a matched control with pathological 24-hour pH monitoring.