The researchers studied the frequency of acid-related esophageal dysfunction in patients with nutcracker esophagus (hypersensitive esophageal contraction).
They reported their findings in the September issue of the Scandinavian Journal of Gastroenterology.
Nutcracker esophagus (NE) is the most common motility abnormality associated with cardiac-like chest pain. However, its significance for the development of symptoms has been a matter of controversy for decades. Recently it has been suggested that NE might represent a primarily acid-related esophageal disorder.
A total of 572 consecutive patients were included in the study. All had undergone esophageal manometry and 24-hour pH monitoring between 1993 and 1998.
A motility pattern consistent with NE was found in 45 subjects. These patients were referred because of chest pain (n=35), reflux dyspepsia only (n=8) or epigastric pain (n=2).
Acid-related esophageal dysfunction was noted in 70% of the NE patients. Irregularities noted were abnormal acid exposure time (n=21), esophagitis (n=2) or positive symptom index (n=7).
|Acid-related esophageal dysfunction in 70% of NE patients
|Scandinavian Journal of Gastroenterology|
In addition, an increased number of reflux episodes were found in another 3 subjects.
The researchers found that NE was more prevalent in subjects referred for chest pain than in those referred for other symptoms (14.3% versus 4.5%). Conversely, 78% of the patients with NE were referred because of chest pain.
M. Börjesson, of the Sahlgrenska University Hospital, said on behalf of fellow authors, "Various aspects of acid-related esophageal dysfunction occur frequently in patients with NE. This suggests that acid may play a role in the development of symptoms in NE.
"Nonetheless, given its association with chest pain, NE could be a marker of a subgroup of patients with acid reflux, distinct from other reflux patients," it was concluded.