Hypercontracting (nutcracker) esophagus

Last revised by Dr Daniel J Bell on 15 Dec 2021

Hypercontracting (nutcracker) esophagus is a motility disorder of the esophagus. This condition is primarily diagnosed with manometry with high intra-esophageal pressure and normal peristalsis. Most patients will have a normal barium swallow

Hypercontracting esophagus ("nutcracker esophagus") differs from diffuse esophageal spasm (corkscrew esophagus). 

Hypercontracting esophagus occurs in 10% of patients with non-cardiac chest pain. 

Presentation includes chest pain, dysphagia, and gastro-esophageal reflux disease.

Etiology is unknown but may be related to gastro-esophageal reflux or stress 2.  

A barium swallow is usually normal. A minority of patients may demonstrate features of non-specific esophageal motility disorder 1,2.  

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Cases and figures

  • Figure 1: nutcracker (photo)
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