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Nutcracker Esophagus

What is nutcracker esophagus?

Nutcracker esophagus refers to having strong spasms of your esophagus. It’s also known as jackhammer esophagus or hypercontractile esophagus. It belongs to a group of conditions related to abnormal movement and function of the esophagus, known as motility disorders.

When you swallow, your esophagus contracts, which helps to move food into your stomach. If you have nutcracker esophagus, these contractions are much stronger, causing chest pain and pain when you swallow.

It’s closely related to diffuse esophageal spasms. The main difference between the two conditions is that nutcracker esophagus usually doesn’t cause you to regurgitate food or liquids, and diffuse esophageal spasms often do.

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Symptoms

What are the symptoms?

The main symptom of nutcracker esophagus is painful swallowing. You may have other symptoms as well, including:

  • sudden and severe chest pain that can last for several minutes or occur on and off for hours
  • trouble swallowing
  • heartburn
  • dry cough
  • feeling like something’s stuck in your throat
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Causes

What causes it?

Nutcracker esophagus is a rare condition. The exact cause of nutcracker esophagus is unknown. However, it seems to be related to an issue with the muscle function and thickness of the esophagus. For some people, the spasms seem to only happen when they eat cold or hot foods. It’s common for people with nutcracker esophagus to also have gastroesophageal reflux disease.

Doctors have identified a few factors that may increase your risk of developing nutcracker esophagus. These include:

  • being over 50 years of age
  • being female
  • having heartburn
  • having gastroesophageal reflux disease (GERD)
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Diagnosis

How is it diagnosed?

Your doctor will start by giving you a physical exam to rule out any underlying conditions. They may also ask you how often you notice the spasms and whether they seem to be related to certain foods. It might be helpful to keep a food diary and note when you feel symptoms during the week or two leading up to your appointment.

Based on the results of your exam, your doctor may suggest a diagnostic test, such as:

  • a barium swallow, which involves swallowing a type of dye that will show up on an X-ray
  • esophageal manometry, which measures the muscle pressure of the esophagus and any spasms
  • endoscopic ultrasound, which can provide detailed information about the muscles and lining of the esophagus
  • endoscopy, which involves using a small camera to look at the inside of your esophagus
  • esophageal pH monitoring, which tests for any signs of acid reflux by measuring the pH in your esophagus
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Treatment

How is it treated?

Most cases of nutcracker esophagus can be treated with a combination of medication and home remedies. In rare cases, you may need additional treatment.

Medications that may help treat nutcracker esophagus include:

  • calcium channel blockers
  • proton pump inhibitors
  • nitrates, such as sublingual nitroglycerin (Nitrostat)
  • hyoscyamine (Levsin)
  • anticholinergic drugs

The following home remedies can also help to relax your esophagus:

  • drinking warm water
  • doing breathing exercises and behavioral techniques for relaxation
  • avoiding foods and drinks that trigger your symptoms

If medication and home remedies aren’t providing any relief, your doctor may suggest additional treatment, such as:

  • a botulinum toxin (Botox) injection to relax the muscles in your esophagus
  • surgery to cut one of the muscles in your esophagus to weaken contractions
  • a POEM procedure (peroral endoscopic myotomy), which uses an endoscope rather than traditional surgery to cut back a section of muscle within the esophagus
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Outlook

Living with nutcracker esophagus

While nutcracker esophagus can be very painful, you may be able to manage it with medications and techniques for relaxing the muscles in your esophagus. In some cases, you may simply need to avoid certain foods. Try to keep track of any patterns you notice with your symptoms. This will help your doctor come up with the most effective treatment plan for you.

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