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Nutcracker Esophagus: This Rare Condition Can Feel Like a Heart Attack

By Kalyana C. Nandipati, MBBS February 08, 2021 Posted in: Gastroenterology

Feeling like food is stuck in your throat or having chest pain can be alarming. Sometimes, these sensations are caused by a condition called nutcracker esophagus or jackhammer esophagus.

This vivid name describes what happens when the muscles in your food pipe (esophagus) go into overdrive. Normally, these muscles contract with a regular coordinated rhythm, moving food smoothly from the mouth to the stomach. It’s so coordinated, you barely notice it.

What is Nutcracker or Jackhammer Esophagus?

Those with nutcracker esophagus have muscle contractions which are irregular, uncoordinated or powerful -- sometimes moving food quickly and painfully. Symptoms include:

  • Chest pain that may last several minutes or occur on and off
  • Heartburn
  • Difficulty or inability to swallow food/liquid
  • Pain with swallowing
  • Sensation of food caught in chest (dysphagia)

Symptoms of chest pain should always be evaluated immediately for a possible heart attack. These symptoms are also sometimes related to GERD, or gastroesophageal reflux or heartburn.

What Causes Nutcracker Esophagus?

The cause of this esophageal condition is unknown, but disruption in nerve activity may play a role. Drinking or eating either very hot or very cold foods can also trigger episodes in some people.

How is Nutcracker Esophagus Diagnosed?

Nutcracker esophagus can be diagnosed with a pressure sensing catheter test called esophageal manometry. This test detects excessive contractions by guiding a catheter through the nose and into the esophagus. While you swallow small sips of water, a computer connected to the catheter measures the pressure, speed and pattern of muscle contractions.

An esophagogram can be performed to show the silhouette of your esophagus. This X-ray is performed after you drink a chalky liquid which covers the lining of your digestive tract.

If you feel like food is stuck in your throat, an upper GI endoscopy may also be performed to ensure the esophagus has no abnormal scars or growths. This test involves passing an endoscope down your throat and into your stomach and duodenum to take videos of your upper GI tract.

Occasional nutcracker esophagus spasms can sometimes be managed by avoiding hot and cold foods and drinks. If your spasms continue, treatments include:

  • Proton pump inhibitors to treat heartburn or GERD or antidepressants to reduce pain sensations.
  • Calcium channel blockers, Botox injections or peppermint oil to reduce severity of spasms.
  • Peroral endoscopic myotomy (POEM) to make an incision in the esophagus inside lining using an endoscope.
  • Surgery (myotomy) to weaken contractions by cutting the muscle at the lower esophagus.

If you think you may have nutcracker esophagus, talk to your health care provider about evaluation and treatment. As always, if you have chest pain, it should be evaluated immediately. The Esophageal Center at CHI Health Creighton University Medical Center – Bergan Mercy has been in the forefront in treating this condition and also providing multiple treatment options which can effectively improve this condition.

Kalyana C. Nandipati, MBBS
Kalyana C. Nandipati, MBBS

Kalyana C. Nandipati, MBBS is a General Surgeon at CHI Health. Dr. Nandipati also specializes in Esophageal Surgery and Bariatric Surgery.

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