Abstract
High-amplitude peristaltic esophageal contractions, or the nutcracker esophagus, may be associated with chest pain or dysphagia. Medical treatment for this disorder is sometimes not satisfactory. We report the manometric and clinical effects of myotomy in four patients with high-amplitude peristaltic contractions who underwent surgery because of the severity of their symptoms and recalcitrance to various medical treatments. Manometry 1–5 years after surgery showed a reduction in amplitude, duration, and percent bipeaked waves at 5 and 10 cm above the lower esophageal sphincter. Peristalsis was abolished or decreased in the distal 10 cm of the esophageal body but was not affected more proximally. Lower esophageal sphincter pressure was decreased in all patients. The manometric changes were least marked in one patient, who was the only one who had some chest pain when last seen five years after myotomy. We conclude that in severely symptomatic patients with high-amplitude peristaltic contractions, myotomy results in marked manometric changes and marked clinical improvement. Patients with this disorder and whose chest pain is recalcitrant to extensive medical therapy may be successfully treated by surgical myotomy.
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Brand DL, Martin D, Pope CE: Esophageal manometrics in patients with angina-like chest pain. Dig Dis Sci 22:300–304, 1977
Benjamin SB, Gerhardt DC, Castell DO: High-amplitude, peristaltic esophageal contractions associated with chest pain and/or dysphagia. Gastroenterology 77:478–483, 1979
Orr WC, Robinson WG: Hypertensive peristalsis in the pathogenesis of chest pain: Further exploration of the “nutcracker” esophagus. Am J Gastroenterol 77:604–607, 1982
Herrington JP, Burns TW, Balart LA: Chest pain, dysphagia, and high-amplitude esophageal peristalsis: A clinical and manometric study. South Med J 76:599–602, 1983
Traube M, Albibi R, McCallum RW: High-amplitude peristaltic esophageal contractions associated with chest pain. JAMA 250:2655–2659, 1983
Winters C, Artnak EJ, Benjamin SB, Castell DO: Esophageal bougienage in symptomatic patients with nutcracker esophagus, a primary esophageal motility disorder. JAMA 252:363–366, 1984
Traube M, McCallum RW: Further manometric characterization of the nutcracker esophagus: Comparison to normal subjects. Clin Res 32:693A, 1984 (abstract)
Clouse RE, Staiano A: Contraction abnormalities of the esophageal body in patients referred for manometry: A new approach to manometric classification. Dig Dis Sci 28:784–791, 1983
Clouse RE, Lustman PJ: Psychiatric illness and contraction abnormalities of the esophagus. N Engl J Med 309:1337–1342, 1983
Richter JE, Spurling TJ, Cordova CM, Castell DO: Effects of oral calcium blocker, diltiazem, on esophageal contraction: Studies in volunteers and patients with nutcracker esophagus. Dig Dis Sci 29:649–656, 1984
Traube M, Hongo M, Magyar L, McCallum RW: Effects of nifedipine in achalasia and in patients with high-amplitude peristaltic esophageal contractions. JAMA 252:1733–1736, 1984
Hongon M, Traube M, McCallum RW: Comparison of effects of nifedipine, propantheline bromide, and the combination on esophageal motor function in normal volunteers. Dig Dis Sci 29:300–304, 1984
Traube M, Lagarde S, McCallum RW: Isolated hypertensive lower esophageal sphincter: Treatment of a resistant case by pneumatic dilatation. J Clin Gastroenterol 6:139–142, 1984
Richter JE, Castell DO: Diffuse esophageal spasm: A reappraisal. Ann Intern Med 100:242–245, 1984
Ellis FH, Code CF, Olsen AM: Long esophagomyotomy for diffuse spasm of the esophagus and hypertensive gastroesophageal sphincter. Surgery 48:155–169, 1960
Leonardi HK, Shea JA, Crozier RE, Ellis FH: Diffuse spasm of the esophagus: clinical, manometric, and surgical considerations. J Thorac Cardiovasc Surg 74:736–743, 1977
Jamieson GG, Duranceau AC: Esophageal myotomy and gastroesophageal reflux. Surg Clin North Am 63:877–884, 1983
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Traube, M., Tummala, V., Baue, A.E. et al. Surgical myotomy in patients with high-amplitude peristaltic esophageal contractions. Digest Dis Sci 32, 16–21 (1987). https://doi.org/10.1007/BF01296682
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DOI: https://doi.org/10.1007/BF01296682