Nutcracker upper esophageal sphincter

Fernando A. M. Herbella, Julia R. Kalluf, Pedro Norton, Fernanda M. Lafraia, Marco G. Patti


Background: Different manometric patterns characterize named well-defined motility disorders of the esophageal body. The detailed study of the upper esophageal sphincter (UES); however, has been neglected. It is elusive whether a similar condition as the nutcracker esophagus exists in the UES. This study aims to evaluate the prevalence and characteristics of patients with “nutcracker UES”.
Methods: We retrospectively reviewed 1,000 esophageal function tests to identify patients with UES basal pressure above 190 mmHg (2 standard deviation above the average in volunteers studied in our laboratory). Demographic data and manometric parameters for the lower esophageal sphincter (LES), esophageal body and UES were recorded as well as pH monitoring variables.
Results: Thirty-one patients were selected (prevalence 0.3%). There were 9 (29%) males, mean age 40±11 (range, 15–60) years. LES basal pressure was 16±15 mmHg (52% were hypotonic and 3% hypertonic). Two (6%) had a nutcracker esophagus. UES basal pressure was 235±89 mmHg. Ten (32%) had pathologic reflux with equal distribution of reflux pattern (supine vs. orthostatic). Six (19%) had extra-esophageal symptoms.
Conclusions: In conclusion, nutcracker UES has a low prevalence in patients that undergo esophageal manometry. There is not a specific demographic group at risk for this manometric condition. Manometric parameters of the LES and esophageal body are not specific for this condition.