Clinical Significance of Marshmallow Esophagography in Patients with Nutcracker Esophagus and Ineffective Esophageal Motility

Lee, Sang Bae; Park, Hyo Jin; Kim, Young Gyun; Choi, Sung Woo; Cho, Min Ho; Lee, Sang In

Abstract

BACKGROUND/AIMS
Ineffective esophageal motility (IEM) and a nutcracker esophagus can lead to hypocontractile dysmotility and hypercontractile dysmotility, respectively. We evaluated patients for the abnormalities of marshmallow esophagography and we compared the esophageal symptoms with the esophageal manometric findings in the patients.
METHODS
We included total 96 patients; there were 23 patients with IEM, 36 patients with nucracker esophagus, 37 individuals with esophageal symptoms who remained in the the normal esophageal manometric group, and 9 asymptomatic healthy controls. The distal esophageal body pressure and the lower esophageal sphincter pressure were examined with respect to the grade of marshmallow esophagography.
RESULTS
The nine healthy volunteers displayed no abnormal marshmallow transit. However, 43.5% of the patients with IEM and 36% of the patients with nutcracker esophagus displayed abnormal marshmallow transit. There was a statistical difference between the healthy volunteer group and those patients with nutcracker esophagus or IEM (p<0.05). Abnormal marshmallow esophagography occurred more frequently for the non-transmitted contraction and the combined type of IEM (non-transmitted contraction and low-amplitude contraction) (p<0.05). However, there was no difference between the distal esophageal pressure and the grade of the marshmallow esophagography. Furthermore, nutcracker esophagus did not display any significant relationship with the distal esophageal pressure and the lower esophageal sphincter pressure with respect to the grade of the marshmallow esophagography.
CONCLUSIONS
Although the measurement of the distal esophageal pressure and the lower esophageal sphincter pressure did not provide statistically significance for the marshmallow transit in IEM and the nutcracker esophagus, the non-transmitted contraction and the combined type provided a statistically significant result for IEM.