24-hour Ambulatory Esophageal Manometric Finding in Nutcracker Esophagus

Hwang, Il Ran; Kim, Jin Hong; Lee, Kwang Jae; Kim, Jung Min; Cho, Sung Won

Abstract

BACKGROUND/AIMS
The most common abnormality of esophageal motility in patients with noncardiac chest pain is reported as nutcracker esophagus. However, its manometric finding may be a transient phenomenon accompanying chest pain rather than a diagnosis. We performed this study to evaluate whether the high amplitude peristaltic contraction is persistent in patients with nutcracker esophagus during 24-hour recording. METHODS: Sixteen patients (M:F=1:1, mean age; 41.0 years) with nutcracker esophagus which was diagnosed by conventional esophageal manometry with water-perfused catheter, were studied. The 24-hour ambulatory esophageal manometry/pH metry recording was performed with a three-channel solid state microtransducer and a one-channel pH probe. RESULTS: Total 32 episodes of chest pain were identified during the 24-hour recording in 9 out of the 16 patients as compared with no pain episode during conventional manometry. During chest pain, the mean amplitude of distal esophageal contractions was 74.4+/-23.1 mmHg. Thirty (94%) episodes were correlated with the case above 95th percentile of amplitude of all esphageal contractions in each patient. The frequency of high amplitude contraction more than 180 mmHg was 7.9+/-9.0% in total recording, 12.6+/-15.4% in meal, 7.2+/-10.3% in upright position, 8.4+/-8.9% in supine position, 3.6+/-7.4% in pain episode. CONCLUSIONS: The high amplitude peristaltic contraction in distal esophagus was not persistent in patient with nutcracker esophagus during 24-hour recording. This result supports that the high amplitude peristaltic contractions may be a transient esophageal dysmotility associated with chest pain.