A Guide to Nutcracker Esophagus and Foods That Can Trigger It

Medically Reviewed By Cynthia Taylor Chavoustie, MPAS, PA-C
Was this helpful?
3

Nutcracker esophagus is a disorder of the esophagus. It affects the function of the esophagus by causing repetitive muscle contractions that are too strong. This pattern of contraction prompted a more recent name, jackhammer esophagus. Doctors may also call it hypercontractile esophagus or hypercontractile peristalsis.

This article explains nutcracker esophagus, the symptoms, causes, and treatment.

What is nutcracker esophagus?

Girl holding her throat
Antonio Molina Soler/EyeEm/Getty Images

Nutcracker esophagus is an esophageal motility disorder. It affects how muscles function in the tube that connects the mouth to the stomach. 

Generally, the esophageal muscle contracts in a smooth, coordinated manner. This moves food into the stomach. With nutcracker esophagus, the force of these contractions is higher than normal. However, the effect on muscular function does not always have a clear relationship to symptoms. 

Nutcracker esophagus is an older name for a hypercontractile esophagus. The condition got its name after manometry testing showed a forceful squeezing closed the esophagus like a nutcracker.

Newer technology using high-resolution manometry showed that the pounding contraction is similar to a jackhammer. Hence the nickname jackhammer esophagus.

What are the symptoms of nutcracker esophagus?

The two main symptoms of nutcracker esophagus are dysphagia and chest pain. Dysphagia is trouble swallowing or feeling like food is stuck. The chest pain that occurs can resemble a heart attack

Heartburn and gastroesophageal reflux disease (GERD) symptoms often occur with nutcracker esophagus.

What is the cause of nutcracker esophagus?

The cause of jackhammer esophagus is unknown. It often occurs with other conditions, including gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS). However, it is unclear whether it is a consequence of another condition.

What are the risk factors for nutcracker esophagus?

Risk factors for nutcracker esophagus are not clearly defined. Research into the demographics of people with nutcracker esophagus has suggested some trends. In one study, people with nutcracker esophagus tended to:

  • be female
  • be older
  • experience heartburn
  • have a coexisting mental health diagnosis
  • have a history of GERD, IBS, or fibromyalgia
  • take acid-suppressing medications

How do you diagnose nutcracker esophagus?

To diagnose an esophageal motility disorder, doctors take a medical history and perform an exam. Testing is usually necessary and may include:

  • barium swallow, or upper gastrointestinal (GI) series, which takes a series of X-rays using barium as a contrast agent
  • esophageal manometry, which measures the pressure inside the esophagus
  • pH testing, which is a common test for GERD
  • upper GI endoscopy, which allows doctors to directly view the inside of the digestive system using a lighted video endoscope

Doctors can measure pressures at various levels of the esophagus using high-resolution manometry. A nutcracker esophagus diagnosis involves two pressure readings above 8,000 millimeters of mercury per centimeter per second at the esophagogastric junction.

The esophagogastric junction is where the esophagus and stomach meet. Pressure readings are measured while the junction is relaxed.

How do you treat nutcracker esophagus?

There is no cure for nutcracker esophagus. Instead, treatment aims to minimize the intensity of esophageal contractions and manage gastroesophageal reflux disease (GERD) symptoms, such as heartburn and regurgitation if present.

Possible nutcracker esophagus treatment options include:

  • GERD therapy: This involves a bland diet, small meals, and acid-reducing medications, including proton pump inhibitors and H2 blockers.
  • Botulinum toxin injections: This medication paralyzes the muscle to relax it temporarily.
  • Medications: Calcium channel blockers or nitrates can relax muscles, although this off-label use is not a first-line treatment
  • Per oral esophageal myotomy (POEM): This is surgery to cut the muscle. For many patients, it may be the most effective treatment

How do you prevent nutcracker esophagus?

Since scientists do not understand exactly what causes nutcracker esophagus, it is not currently possible to prevent it. 

Since GERD may coexist with nutcracker esophagus, minimizing the risk factors for and treating GERD symptoms, if present, may improve nutcracker esophagus symptoms.

There are several other esophageal motility disorders, including:

  • achalasia, which occurs when the lower esophageal sphincter does not relax to allow food to pass into the stomach
  • diffuse esophageal spasms, which are uncoordinated esophageal contractions that do not propel food downward
  • gas
  • GERD, when stomach acid flows back into the esophagus
  • eosinophilic esophagitis, which is a buildup of white blood cells in the esophagus causing inflammation and damage

What foods can trigger esophagus spasms?

In people with jackhammer esophagus, very hot or very cold liquids can worsen swallowing problems.

Spicy or acidic food can cause heartburn, worsen GERD systems, and trigger a hypercontractile spasm.

Stress and loud noises may also aggravate the condition.

What are the potential complications of nutcracker esophagus?

Nutcracker esophagus can progress to achalasia. In achalasia, food and liquids remain in the esophagus because the muscles will not allow them to pass through to the stomach.

Frequently asked questions

Here are some questions people often ask about nutcracker esophagus.

What is the difference between nutcracker esophagus and diffuse esophagus spasm or corkscrew esophagus?

Diffuse esophageal spasm is also an esophageal motility disorder. It causes varying contractions with increased muscle activity and uncoordinated contractions that do not propel food. It gets the name corkscrew from the telltale appearance of the inside of the esophagus. Nutcracker esophagus has a normal, coordinated pattern of contractions. They are just too strong.

How long does nutcracker esophagus last?

When diagnosing nutcracker esophagus with manometry, doctors look for prolonged contractions that last more than 6 seconds.

What does it feel like when your esophagus spasms?

People experiencing an esophageal spasm may have difficulty swallowing or feel a sensation of food being stuck. Chest pain can also occur.

Summary

Nutcracker esophagus, an esophageal motility disorder, is not clearly understood. The medical name for it is hypercontractile esophagus. The condition causes the esophageal muscles to contract too intensely.

High-resolution manometry shows that these contractions are repetitive, and its new nickname, jackhammer esophagus, reflects this. When nonsurgical approaches do not provide relief, surgery is an effective way to treat nutcracker esophagus. 

Was this helpful?
3
Medical Reviewer: Cynthia Taylor Chavoustie, MPAS, PA-C
Last Review Date: 2022 Aug 29
View All Digestive Health Articles
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Goyal, M., et al. (2022). Esophageal motility disorders. https://www.ncbi.nlm.nih.gov/books/NBK562155/
  2. Hong, Y. S., et al. (2016). Two distinct types of hypercontractile esophagus: Classic and spastic jackhammer [Abstract]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5003212/
  3. Jackhammer esophagus. (n.d.). https://rarediseases.org/gard-rare-disease/jackhammer-esophagus/
  4. Jackhammer esophagus. (n.d.). https://www.uclahealth.org/esophageal-center/jackhammer-esophagus
  5. Lufrano, R., et al. (2015). Nutcracker esophagus: Demographic, clinical features, and esophageal tests in 115 patients. https://academic.oup.com/dote/article/28/1/11/2328611?login=false
  6. Lynch, K. L. (2022). Diffuse esophageal spasm (corkscrew esophagus).  https://www.merckmanuals.com/professional/gastrointestinal-disorders/esophageal-and-swallowing-disorders/diffuse-esophageal-spasm
  7. Lynch, K. L. (2022). Esophageal motility disorders. https://www.merckmanuals.com/professional/gastrointestinal-disorders/esophageal-and-swallowing-disorders/esophageal-motility-disorders
  8. Rohof, W. O. A., et al. (2017). Chicago classification of esophageal motility disorders: Lessons learned. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5519653/