Nutcracker Oesophagus (redirected from Segmental Spasm of Oesophagus)

Nutcracker Oesophagus

A nonprogressive dysmotility disorder of the oesophagus which primarily affects older adults. While it may be asymptomatic, it often manifests itself as chest pain, less commonly as dysphagia for solid and liquid foods
Diagnosis Oesophageal manometry; the diagnosis is made at intraoesophageal pressure above 180 mm Hg, a pressure fancifully likened to that of a nutcracker, hence the name
Management
• Reduce risk factors Weight loss; it is unclear if acid suppression, to reduce oesophageal reflux, is effective
• Medical therapy Calcium-channel blockers to relax the lower oesophageal sphincter (LOS) and reduce dysphagia; diltiazem; nitrates—e.g., pre-prandial isosorbide dinitrate—may also relax the LOS; phosphodiesterase inhibitors—e.g., sildenafil—may be of use; trazodone, an anti-depressant, may reduce visceral sensitivity and chest pain
• Endoscopic therapy Botulinum toxin (Botox) temporarily improves symptoms; balloon dilation to stretch LOS muscles may improve work
• Surgery As a last resort, a Heller myotomy can disrupt the LOS and the myenteric plexus that innervates it.