Nutcracker oesophagus Home A-Z Health Information Health Library A-Z Nutcracker Oesophagus Overview This condition also known as hypercontractile oesophagus or jackhammer oesophagus is characterised by excessively strong (and prolonged) oesophageal contractions, resulting in pain and dysphagia (difficulty swallowing). The contractions may be normal in frequency but are excessively forceful. Cause Neuromuscular dysfunction: Disrupted neural regulation of the oesophagus, including impaired inhibitory neurotransmission, may lead to hypercontractility.Chronic acid refluxPsychological stressOesophageal inflammation: Conditions like eosinophilic esophagitis or general esophagitis may disrupt normal motility.Genetic predispositionGastroesophageal reflux disease (GERD)AgeingDietary triggers: Certain foods and drinks, especially those that are spicy or acidic, may trigger or worsen symptoms. Symptoms Dysphagia (difficulty swallowing)Intense chest pain that is occasionally confused with a heart attackSensation of food getting stuck in the throatHeartburn (burning sensation in the chest) Diagnosis Oesophageal manometry: This is the primary diagnostic modality for nutcracker oesophagus. Diagnosis is based on the detection of hypercontractile contractions.Oesophageal high-resolution manometry (HRM): This is a more advanced form of manometry. It can provide a more detailed, topographic map of pressure changes in the oesophagus and may be particularly helpful in differentiating nutcracker oesophagus from other oesophageal motility disorders.Endoscopy: It is typically normal in nutcracker oesophagus and is performed to exclude other structural or inflammatory causes (e.g., tumours, strictures, or GERD-related esophagitis). Treatment Medications: Various medications are used to relax the oesophagusCalcium channel blockersNitratesBotulinum toxin injectionsProkinetic medications (e.g., metoclopramide, domperidone)Antidepressants (to regulate oesophageal nerve activity)Surgical myotomy: In some cases, myotomy (a procedure involving trimming the circular fibres of the lower oesophageal sphincter (LES) to facilitate movement of food along the food pipe may be considered (if conservative measures fail).