RESUMO
Objectives To investigate the pathophysiologic mechanisms and the clinical character- istics and variations of nutcracker esophagus(NE).Methods Clinical data obtained from 22 patients with NE were retrospectively analyzed.Seven followed-up patients had esophageal motility,multi-channel electrogastrography(MEGG),the autonomic nervous system(ANS) and psychology tests and were com- pared to 10 healthy subjects(HS).Results①In NE group,12 patients had reflux symptom(55%),7 patients had chest pain(32%)and 3 patients had dysphagia(13%).There was no statistical difference in mean contraction amplitude(MCA) between patients with reflux symptom and chest pain.②Eight out of the 13 patients with NE who received 24 h pH monitoring were positive reflux,and 4 out of 17 patients had reflux esophagitis in endoscopic examinations.The symptoms were improved in 58%patients(7/12) by regular acid-suppression therapies.③There was no statistical difference beween NE and HS groups in dominant frequency and power of MEGG.However,the percentages of normal rhythm in preprandial and slow wave coupling in pre and postprandial of NE patients were significantly decreased than those in HS.④The ANS function in NE group had no statistical difference compared to those in HS.⑤In follow- up group,no difference was found before and after nitroglycerin sublingually.Four patients had depres- sion.Conclusions The clinical presentations of NE are vary.The symptoms of NE were poorly correla- ted with MCA,but partially correlated with GER,which may represent a special subtype of GERD. Gastric dysmotility and psychological factors might contribute to the pathogenesis of NE.