Psychological comparison of patients with nutcracker esophagus and irritable bowel syndrome

Recent evidence suggests that psychological factors may affect esophageal as well as intestinal motility. To study this further, we compared the psychological profiles of 20 irritable bowel patients and 20 patients with recurrent noncardiac chest pain associated with high-amplitude peristaltic contractions in the distal esophagus, the "nutcracker esophagus." Three control groups with 20 patients each also were evaluated. The Millon Behavioral Health Inventory was administered to all subjects. This is a 150-item self-report instrument developed to assess psychological impact of medical illnesses in nonpsychiatric populations. The nutcracker and irritable bowel patients differed significantly (P less than 0.05) from controls on scales of gastrointestinal susceptibility and somatic anxiety, suggesting that these patients react to psychological stress with an increase in symptom frequency and severity. They also tend to be hypochondriacal and seek early medical care. Irritable bowel patients, however, have a more generalized disorder, as they also scored significantly higher (P less than 0.05) than the other groups on three general measures of depression and anxiety.

as previously observed in the irritable bowel syndrome, emotional factors may modulate pain perception in the nutcracker esophagus. Simple psychometric instruments like the Millon Behavioral Health Inventory may be useful in identifying these patients who may benefit from psychotropic drugs or behavior modification.