This condition is a type of esophageal convulsion identified by effective contractions that happen when swallowing. It is typically caused by gastroesophageal reflux, the backflow of stomach acid up the esophagus, which causes heartburn.
Heartburn that happens more than twice a week is called gastroesophageal reflux disease (GERD), a more serious condition that, left untreated, can cause problems such as chronic inflammation of the esophagus (esophagitis) and a precancerous condition called Barrett’s esophagus.
Nutcracker esophagus is a type of a motility condition of the esophagus. While this condition can affect people of any age group, it is more frequent amongst senior people in the age of 60 to 80 years. In basic this disorder is self-limiting and doesn’t progress and for this reason the focus of treatment is to focus on managing the symptoms related to the condition.
This condition is referred to as ‘Nutcracker esophagus’ because an evaluation of pressure in the esophagus at various points during the procedure of peristalsis matches with the pressure of a mechanical nutcracker, which goes beyond 180mmHg.
There are two key symptoms that are connected with this motility condition that include chest pain (which is of non-cardiac origin) and dysphagia (difficulty in swallowing food). These symptoms are usually intermittent and might happen during the intake of food or otherwise.
Rarely is this condition associated with sudden obstruction, which might ultimately need urgent hospitalization and treatment. Thankfully this condition is not associated with other physiological abnormalities consisting of strictures or esophageal cancer.
Symptoms of Nutcracker Esophagus
The symptoms of nutcracker esophagus can be worrying– chest pain so severe that it can be mistaken for a cardiovascular disease and the sensation that food is stuck under the breastbone.
Since GERD is likely to be the cause, I suggest that you take steps to handle that. This requires resolving lifestyle factors such as smoking and excess weight along with eating small, frequent meals instead of 3 big ones, preventing lying down within 3 hours of eating, not eating foods that appear to activate your symptoms and preventing tight clothes, particularly around your midsection.
In addition to these measures, traditional medication generally deals with GERD with medication. Many patients are advised to begin taking non-prescription antacids, which I encourage preventing because they only mask the symptoms.
What are the Causes of Nutcracker Esophagus?
The cause connected with nutcracker esophagus is unknowned. There is no considerable pathophysiological irregularity in patients with nutcracker esophagus.
Experts recommend that the condition can be attributed to abnormalities in neurotransmitters that manage the distal part of the esophagus. Others recommend the condition may be connected with modification in nitric oxide levels which might lead to reflux action.
In patients struggling with dysphagia, barium swallow studies are carried out in order to determine any anatomical conditions within the esophagus. Barium swallow studies are followed with an endoscopic examination of the walls of the esophagus, nevertheless for the most parts, endoscopy research study findings are normally normal.
Esophageal motility research studies are essential in nutcracker esophagus. Esophageal motility research study determines the pressure across the esophagus, during the movement of food through the esophagus.
There are two requirement for diagnosis of this condition, to start with the mean amplitude at the distal part of the esophagus should be more than 180 mmHg and second of all there must be two consecutive contractions which should last for a duration of more than 6 seconds.
Diet for Nutcracker Esophagus
While there is no genuine treatment for this condition and hence dietary correction plays an important function in relieving the symptoms of pain and dysphagia. Here are some crucial pointers,
- The significant component of the diet should comprise of fluids and soft foods. Eat really small amounts of food, take small sips of fluid. Big bolus of food can trigger an episode of dysphagia.
- Prevent oily, spicy and starchy foods and also meat. Trans fats must be completely avoided.
- Eat small amounts of food regularly during the day. Don’t have a heavy meal; rather divide your regimen into six small meals through the day.
- Take in fresh fruits or fruit juices only in the early morning, considering that fruits have the tendency to ferment when they mix with other types of food and cause gaseous distension, which can activate dysphagia.
- Prevent fermented foods or high fiber diet, as they can likewise add to distention and cause dysphagia.
- Keep a log to track the foods and beverages that trigger or aggravate your symptoms. Particular foods and drinks weaken or relax the esophageal sphincter including peppermint, citrus and caffeine. Other foods have also been linked– tomatoes, garlic, dairy products and high-fat meals. Wheat and other grains including gluten (oats, barley and rye) are problems for some people.
- Increase your fiber intake to at least 40 grams a day, including entire grains, vegetables and fruits.
- Get routine workout.
- Drink lots of water.
- Prevent caffeinated beverages (including decaffeinated coffee), which can aggravate the intestinal tract.
- Use DGL (deglycyrrhizinated licorice), which is available in chewable tablets and in powder form. Slowly chew two tablets or take a half-teaspoon of the powder prior to or in between meals and at bedtime. Taper your dose down after your symptoms are under control.
Nutcracker Esophagus Treatment
Given that this condition is not connected with any complications the focus of the treatment is to minimize the intensity of the symptoms. This condition cannot be cured however there are specific medications that might be useful in relieving the symptoms.
Periodically dilation of the distal part of the esophagus with endoscopic balloons is also a tested and shown treatment option.
If antacids do not help, drugs to block stomach acid production might be recommended. It is not a smart idea to use these drugs long term, both due to the fact that they have considerable side effects and since they can get worse the condition in time.
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