Demographic and Clinical Characteristics of Patients with Nutcracker Esophagus

Objective: This retrospective study was designed to investigate the demographic and clinical characteristics of 77 patients diagnosed with nutcracker esophagus (NE). Materials and Methods: The medical records of patients with NE who were followed up at a single center between 2000 and 2020 were collected and analyzed. Results: The average age of the patients was 52.5 +/- 15.7 years; 43 (55.8%) were male and 34 (44.2%) were female. Dysphagia was the primary symptom in 49 patients (63.6%) and noncardiac chest pain (NCCP) symptoms were prominent in 28 patients (36.4%). Esophageal manometry results according to the presenting symptom indicated that the median amplitude was 210 mmHg (min-max: 190-270 mmHg) in those with prominent NCCP and 215 mmHg (min-max: 190-310 mmHg) in those with prominent dysphagia, with no statistically significant difference between the groups (p=0.19). The mean lower esophageal sphincter pressure (LESP) of the patients was 25 mmHg (min-max: 10-80 mmHg). While the pressure was normal in 55 patients (71%), was elevated in 22 patients (29%). Comparison of the LESP results revealed that the distal esophageal amplitude (DEA) median was 220 mmHg (min-max: 190-310 mmHg) in patients with normal LESP and 210 mmHg (min-max: 190-250 mmHg) in those with a high LESP. Normal or high LESP was not associated with high DEA (p=0.57). Conclusion: Patients with NE may present with a variety of symptoms. The presence of reflux should be investigated and symptomatic treatment should be applied.