Distal Esophageal Hypercontractility Is Related to Abnormal Acid Exposure

Background and Aims: Nutcracker esophagus (NE) is a frequent primary motility disorder of the distal esophagus, and the relationship with acid exposure remains controversial. We studied simultaneous distal esophageal hypercontractility (EH) using two sensors at 8 and 3 cm above the lower sphincter (LES) and abnormal exposure to acid (pH DeMeester score). Methods: From 400 screened patients with chest pain and heartburn, 54 (age 44.5 ± 8.8 years and 74% females) had abnormal manometry and underwent acid exposure measurement. Frequencies of the EH disorder were classic NE (EH_{3 cm}) found in 29 (40.8%) patients, diffuse (EH_{3,8 cm}) in 30 patients (42.3%), and upper segmental (EH_{8 cm)} in 12 patients (16.9%). Results: We found a positive correlation among age with high amplitude in EH_{3 cm} and EH_{3,8 cm}. DeMeester's score (DMS) had the lowest value for EH_{3,8 cm} (2.58 ± 0.23) compared with EH_{8 cm} (3.78 ± 0.3, p <0.003) and EH_{3 cm} (3.12 ± 0.2, p <0.06). Surface response for joint effect of age and DMS on amplitude at EH_{3 cm} confirmed the highest amplitude was for older age and lower DMS. Conclusions: EH_{3 cm} and EH_{3,8 cm} were common for esophageal motility and were inversely associated with DMS. Meanwhile, acid exposure was higher in younger patients and hypercontractility was more frequent in older subjects. The former group may benefit more from proton pump inhibitors and the latter from visceral analgesics or possibly both.