Radiology of the nutcracker esophagus

Area of Science:

• Gastroenterology
• Esophageal Motility Disorders
• Diagnostic Imaging

Background:

• Nutcracker esophagus is a manometrically diagnosed esophageal motility disorder.
• Patients often present with angina-like chest pain or dysphagia.

Purpose of the Study:

• To evaluate the diagnostic sensitivity of video-esophagram for nutcracker esophagus.
• To assess the utility of barium swallow in patients with symptoms suggestive of nutcracker esophagus.

Main Methods:

• Prospective evaluation of 22 patients with manometrically confirmed nutcracker esophagus.
• All patients underwent video-recorded barium esophagram.
• Radiologist reviewed videos unaware of manometric diagnoses.

Main Results:

• Video-esophagram was normal in 55% of patients.
• 36% showed dysmotility (diffuse spasm or tertiary contractions).
• Hiatal hernia was found in 2 patients.

Conclusions:

• Barium swallow lacks sufficient sensitivity to screen for nutcracker esophagus.
• Abnormalities like diffuse spasm or tertiary contractions may indicate the disorder but are not consistently detected.
• This imaging modality is inadequate for patients with atypical angina or dysphagia potentially due to nutcracker esophagus.