Nut Cracker Esophagus

  • – This is a manometric abnormality of High Amplitude (strength) Peristaltic Contraction (HAPC)
  • – Esophageal contraction proceed in a coordinated manner but the amplitude of the contractions is excessive (meaning contractions are too powerful)
  • – The LES relaxes normally in nutcracker esophagus, but has an elevated pressure of >40 mm Hg at baseline
  •              Castel criteria for nut cracker esophagus:
  • Major criteria
  • – Mean peristaltic amplitude in the distal esophagus is > 180 mm Hg
  • Minor criteria
  • – Presence of repetitive contraction (2 or more) that are greater than 6 seconds in duration


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