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Nut cracker oesophagus

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Oesophageal spasm is a relatively uncommon condition.

Oesophageal spasm usually affects the elderly and is associated with muscular hypertrophy of the lower oesophagus. It may present with a chest pain that may mimic angina.

On barium swallow there is abnormal peristalsis - corkscrew oesophagus - with uncoordinated contractions.

It is managed conservatively:

  • avoidance of precipitating factors, e.g. hot or cold food
  • muscle relaxants may be effective, e.g. isosorbide mononitrate and nifedipine
  • proton pump inhibitors: may be needed if there is associated reflux

Surgical options include:

  • endoscopic balloon dilatation of the gastro-oesophageal sphincter
  • oesophagomyotomy: rarely used
  • laparoscopic Heller myotomy is thought to be the surgical treatment of choice for diffuse oesophageal spasm
  • oesophagectomy: very rarely used if symptoms are intractable


  • mortality rate is virtually nil, but there can be much morbidity
  • chest pain and dysphagia can lead to an inability to eat and subsequent malnutrition


  • the term "nutcracker oesophagus" is used to describe when the oesophageal contractions are coordinated but with an excessive amplitude
    • food can usually pass down the oesophagus but pain is a common feature

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