Esophageal Motility Disorders (Nutcracker Esophagus)

Disorders affecting the motor function of the UPPER ESOPHAGEAL SPHINCTER; LOWER ESOPHAGEAL SPHINCTER; the ESOPHAGUS body, or a combination of these parts. The failure of the sphincters to maintain a tonic pressure may result in gastric reflux of food and acid into the esophagus (GASTROESOPHAGEAL REFLUX). Other disorders include hypermotility (spastic disorders) and markedly increased amplitude in contraction (nutcracker esophagus).

Also Known As:

Networked: 204 relevant articles (7 outcomes, 35 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Chest Pain (Chest Pains)
2.	Muscle Spasticity (Spastic)
3.	Livedo Reticularis
4.	Myositis (Idiopathic Inflammatory Myopathies)
5.	Heart Failure

Experts

1.	Rubesin, Stephen E: 3 articles (01/2008 - 07/2006)
2.	Levine, Marc S: 3 articles (01/2008 - 07/2006)
3.	Laufer, Igor: 3 articles (01/2008 - 07/2006)
4.	Reavis, Kevin M: 2 articles (04/2014 - 11/2006)
5.	Silva, Luciana C: 2 articles (10/2013 - 04/2013)
6.	Patti, Marco G: 2 articles (04/2013 - 01/2008)
7.	Katzka, David A: 2 articles (12/2007 - 07/2006)
8.	Coffin, Benoit: 2 articles (07/2007 - 06/2007)
9.	Jouet, Pauline: 2 articles (07/2007 - 06/2007)
10.	Merrouche, Mohamed: 2 articles (07/2007 - 06/2007)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Esophageal Motility Disorders:

1.	Botulinum Toxins (Botulinum Toxin)IBA 10/01/1996 - "We conclude that botulinum toxin injection at the gastroesophageal junction leads to significant symptom improvement in patients with nonachalasia esophageal motility disorders. " 09/01/2013 - "Endoscopic injection of botulinum toxin (BTX) has shown benefits for patients with diffuse esophageal spasm (DES) and nutcracker esophagus (NE) in small uncontrolled trials. " 10/01/1996 - "The purpose of this study was to determine if botulinum toxin injection at the lower esophageal sphincter improves symptoms in patients with nonachalasia spastic esophageal motility disorders. " 09/01/2013 - "Botulinum toxin reduces Dysphagia in patients with nonachalasia primary esophageal motility disorders." 01/01/1999 - "With the exception of botulinum toxin for achalasia, medical therapy of primary esophageal motility disorders is rather limited and the clinical results are poor. "
2.	BariumIBA 12/01/2007 - "Careful evaluation of esophageal motility on postoperative barium studies may help to identify esophageal dysmotility and to differentiate this finding from structural complications of the wrap as a cause of refractory symptoms in these patients." 11/01/2007 - "Preoperative invasive studies (endoscopy, manometry, pH monitoring) and noninvasive studies (barium swallow and radionuclide gastroesophageal motility) revealed esophageal dysmotility in 26 patients. " 07/01/2006 - "The presence of this specific form of esophageal dysmotility on barium studies therefore should suggest underlying reflux disease." 07/01/2006 - "Association between esophageal dysmotility and gastroesophaeal reflux on barium studies." 03/01/2000 - "To evaluate the significance of bread and barium studies as a diagnostic tool as well as a supplement to manometric investigation of the esophagus in patients with suspected esophageal motility disorders. "
3.	Proton Pumps (Proton Pump)IBA 12/01/2010 - "There was no significant difference in age, sex, typical esophageal symptoms, presence of esophageal erosion, esophageal dysmotility, improvement with proton pump inhibitor medication, symptom index ≥ 50%, percentage of time clearance pH below 4 ≥ 4%, and all reflux time ≥ 1.4% in the fasting period between the two groups. " 02/01/2008 - "Inclusion criteria were chronic and symptomatic GERD, proton pump inhibitor (PPI) dependence, and the absence of esophageal motility disorder. " 01/01/2007 - "The aim of this study was to investigate the relationship between the severity of reflux esophagitis and esophageal dysmotility and evaluate the effect of prolonged treatment with proton pump inhibitor (lansoprazole 30 mg/day) on esophageal motility in patients with severe reflux esophagitis associated with esophageal motility disorder. "
4.	AntibodiesIBA 05/01/1992 - "Antibodies to hn-RNP protein A1 in systemic lupus erythematosus: clinical association with Raynaud's phenomenon and esophageal dysmotility." 11/01/2012 - "In cluster 1 the prevalence of PAH (55.8%; p < 0.001), Raynaud's phenomenon (92.2%; p < 0.001) and livedo reticularis (24.6%, p < 0.001) was significantly greater than in cluster 2 and 3. In cluster 2, the incidence of ILD (98.7%; p < 0.001), myositis (77.2%; p < 0.001), and esophageal dysmotility (89.8%; p < 0.001) was significantly greater than that in cluster 1 and 3. In cluster 3, anti-CCP antibodies were present in 31 of 45 patients (68.8%) with erosions. " 05/01/2006 - "Anticentromere antibodies (ACA) are useful in assessing and classifying patients with mild variant of systemic sclerosis called calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasias (CREST) syndrome. " 05/01/1985 - "Twenty-eight patients hd diffuse skin disease, and 14 had the CREST variant of systemic sclerosis (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasis) with anticentromere antibodies. " 01/01/2013 - "Neither was esophageal dysmotility associated with IgG antibodies (OR = 2.500, 95% CI = 0.259-24.096). "
5.	Cyclosporine (Ciclosporin)FDA LinkGeneric 08/27/2003 - "Cyclosporine A-induced achalasia-like esophageal motility disorder in a liver transplant recipient: successful conversion to tacrolimus." 08/01/2002 - "Combination therapy of corticosteroids, methotrexate (MTX), and cyclosporine resulted in improved skin thickness and muscle strength scores in all cases, as well as in lung restrictive syndrome in 2, but was not effective regarding the progression of intestinal malabsorption in one patient, esophageal dysmotility in 3 patients, and dilated cardiomyopathy in 3. Endstage cardiac failure caused 2 deaths. "
6.	Adrenal Cortex Hormones (Corticosteroids)IBA 07/01/1996 - "To our knowledge, this is the first case of sarcoidosis presenting with dysphagia and documented esophageal dysmotility in which symptoms and manometric abnormalities normalized after therapy with systemic corticosteroids." 08/01/2002 - "Combination therapy of corticosteroids, methotrexate (MTX), and cyclosporine resulted in improved skin thickness and muscle strength scores in all cases, as well as in lung restrictive syndrome in 2, but was not effective regarding the progression of intestinal malabsorption in one patient, esophageal dysmotility in 3 patients, and dilated cardiomyopathy in 3. Endstage cardiac failure caused 2 deaths. "
7.	Methotrexate (Mexate)FDA LinkGeneric 08/01/2002 - "Combination therapy of corticosteroids, methotrexate (MTX), and cyclosporine resulted in improved skin thickness and muscle strength scores in all cases, as well as in lung restrictive syndrome in 2, but was not effective regarding the progression of intestinal malabsorption in one patient, esophageal dysmotility in 3 patients, and dilated cardiomyopathy in 3. Endstage cardiac failure caused 2 deaths. "
8.	Diltiazem (Cardizem)FDA LinkGeneric 03/01/1991 - "Only nine of the 14 patients fulfilled presently acceptable criteria for diagnosing nutcracker esophagus, and the diltiazem effect was similar, although not significant, because of the smaller sample. " 03/01/1991 - "Diltiazem therapy for symptoms associated with nutcracker esophagus." 07/01/1984 - "In contrast, most doses of diltiazem significantly (less than 0.05) decreased amplitude and duration of peristaltic contractions in patients with nutcracker esophagus. " 01/01/1984 - "[Diltiazem in esophageal motility disorders]." 11/01/1995 - "Diltiazem, 240-480 mg/day, was given to 4 patients with idiopathic or CREST-related (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasias) calcinosis for 1-12 years. "
9.	Calcium Channels (Calcium Channel)IBA 07/01/1987 - "Esophageal motility disorders and their response to calcium channel antagonists. " 09/21/2010 - "Using Kaplan-Meier analysis and the proportional hazard Cox regression model, it was shown that the administration of a calcium channel antagonist in patients with such an esophageal motility disorder significantly decreased the risk of hospitalization as a result of a suspicion of acute coronary syndrome after the 2.7-year follow-up period. " 05/01/1982 - "These studies suggest that verapamil or other calcium channel blocking agents may be of potential use in the treatment of esophageal motility disorders associated with increased pressure." 03/01/1991 - "In this preliminary study involving 14 patients, the oral calcium channel blocker, diltiazem, appeared to improve noncardiac chest pain associated with strong esophageal contraction, the nutcracker esophagus. " 03/01/1991 - "A randomized double-blind, cross-over prospective trial in 22 patients was designed to evaluate possible effect of an oral calcium channel blocker, diltiazem, on symptoms of chest pain and/or dysphagia in patients with nutcracker esophagus. "
10.	Nifedipine (Adalat)FDA LinkGeneric 01/01/1988 - "One of the nutcracker esophagus showed a pattern of sequential peaks with a similar response to nifedipine. " 09/01/1985 - "We investigated the effects of nifedipine on esophageal contractions in 5 healthy volunteers and 10 patients with the nutcracker esophagus. " 10/05/1984 - "In patients with nutcracker esophagus, nifedipine decreased LES pressure by approximately 50% and contraction amplitude in the body of the esophagus by approximately 25%. " 10/05/1984 - "These results suggest that double-blind, placebo-controlled clinical trials of nifedipine in the treatment of achalasia or nutcracker esophagus are indicated." 07/01/1987 - "Therefore, we compared the effects of oral nifedipine (10-30 mg t.i.d.) and placebo in 20 patients (mean age 50 yr) with chronic noncardiac chest pain and the nutcracker esophagus in a 14-week double-blind crossover study. "

Therapies and Procedures

1.	Sclerotherapy 06/01/1994 - "Sclerotherapy was followed by significantly greater esophageal dysmotility and worsening reflux patterns. " 10/01/1997 - "This is a prospective investigation of esophageal dysmotility after endoscopic injection sclerotherapy and variceal ligation. "
2.	Fundoplication 04/01/2013 - "This study aims to evaluate the outcomes of laparoscopic Nissen fundoplication (LNF) in patients with manometric patterns of esophageal motility disorders. " 04/01/2006 - "This study aimed to evaluate the long-term impact of laparoscopic Nissen fundoplication on esophageal motility in patients with preoperative esophageal dysmotility. " 10/01/2014 - "The choice of surgical management options is debatable between laparoscopic Nissen fundoplication (LNF) and Toupet fundoplication (LTF) especially in cases with esophageal dysmotility. " 04/01/2013 - "Outcomes of laparoscopic Nissen fundoplication in patients with manometric patterns of esophageal motility disorders." 10/01/2010 - "A 360° Nissen fundoplication (NF) was performed on n = 127 patients with a normal esophageal peristalsis, whereas a 270° Toupet fundoplication (TF) was conducted on n = 33 patients having an esophageal motility disorder. "
3.	Bariatric Surgery 05/01/2007 - "This study aimed to determine the prevalence of esophageal motility disorders in obese patients selected for bariatric surgery. " 09/01/2013 - "Esophageal motility disorders after bariatric surgery." 07/01/2007 - "Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients before and after bariatric surgery." 08/01/2004 - "The authors studied a large number of morbidly obese candidates for bariatric surgery with objective means, in order to better define the incidence of gastro-esophageal reflux disease (GERD) and esophageal motility disorders in this population. " 10/01/2012 - "17 patients had banding as one of multiple bariatric surgeries, with 13 complications: band slip (4), port infection (1), esophageal dilation (1), esophageal dysmotility (5), anastomotic leak (1) and internal hernia (2). "
4.	Behavior Control 03/01/2012 - "Thus, the effortful swallow offers a behavioral manipulation of the esophageal phase of swallowing, and future studies will determine its clinical potential for treating esophageal dysmotility in patient populations."
5.	Catheters 06/01/2015 - "The introduction of high resolution manometry (HRM) with up to 36 pressure points that are simultaneously measured on the esophageal catheter has changed diagnosis and assessment, and has led—with the Chicago Classification—to a new functional classification of esophageal motility disorders. " 07/01/2014 - "The Chicago classification for esophageal motility disorders is still valid and the same normal values can be used when catheters with a slightly lower resolution are used (i.e., 2-cm vs 1-cm spacing). " 07/01/2014 - "The Chicago classification for esophageal motility disorders was designed for a 36-channel manometry system with sensors spaced at 1 cm. However, many motility laboratories outside the USA use catheters with a lower resolution in the segments outside the esophagogastric junction. " 09/01/2009 - "The complication frequencies were generally low and included esophageal dysmotility in 0.4%, late balloon failure in 0.4%, band erosion in 0.4%, slippage in 3.3%, esophageal dilation in 3.3%, pouch dilation in 3.6%, catheter kinking in 1.1%, port displacement in 2.5%, and port disconnection in 4.3%. " 07/01/2001 - "Esophagoscopy has multiple roles in the appraisal and treatment of esophageal motility disorders, including the detection of secondary or pseudoachalasia, placement of manometry catheters, and dilation of peptic strictures caused by GERD associated with disorders such as scleroderma."