Lufrano R, Heckman M G, Diehl N, DeVault K R, Achem S R
Medical School, Univerisity of Iowa, Iowa City, Iowa, USA.
Dis Esophagus. 2015 Jan;28(1):11-8. doi: 10.1111/dote.12160. Epub 2013 Nov 20.
Nutcracker esophagus (NE) is a common esophageal motility disorder chacterized by high amplitude peristaltic contractions in the distal esophagus. While previous studies have examined selected aspects of this condition (e.g. pathogenesis and treatment), there is a paucity of data regarding demographic and clinical features in large cohorts of patients. The aim of this study was to describe demographics, clinical features, comorbidities, time to diagnosis, source of patient referral by specialty, and medication use in a large cohort of patients with NE. We retrospectively analyzed consecutive cases of NE diagnosed from 2008-2010. The electronic medical records of these patients were reviewed, and relevant information was extracted. We identified 115 patients with NE. The median age was 62 years (range 25-87 years), and 63% were female. The median time patients experienced symptoms prior to diagnosis was 24 months (0-480 months). Most patients presented to an internal medicine consultant (42%) or to a gastroenterologist (35%). Presenting symptoms were chest pain (31%) and dysphagia (21%). Gastroesophageal reflux disease (GERD) symptoms were common: heartburn occurred in 51% of patients, 77% had a prior history of GERD, and 78% were receiving acid suppressive medications. GERD was confirmed by testing in at least 35%. Psychiatric comorbidity occurred in 24% with half the patients receiving psychotropic medications. Irritable bowel syndrome (IBS) and fibromyalgia co-existed in 15% and 12% of patients, respectively. Surprisingly, opioids were prescribed to 26% of patients. No statistically significant correlation was found between esophageal motility parameters and symptoms. In this study, NE patients were more commonly middle-aged females experiencing a considerable amount of time between symptom onset and diagnosis. Many were initially evaluated by internists for dysphagia or chest pain and had a history of GERD. Medication prescribed prior to diagnoses frequently involved acid suppression, but narcotic and psychotropic prescriptions were also commonly used. Central sensitization syndromes (fibromyalgia and IBS), psychiatric comorbidity, and reflux commonly coexisted. Our study suggests that future investigations should address the role and interaction of GERD and psychiatric disorders in NE.
胡桃夹食管（NE）是一种常见的食管动力障碍性疾病，其特征为食管远端出现高幅度蠕动收缩。虽然既往研究已对该疾病的某些方面（如发病机制和治疗）进行了探讨，但关于大量患者人群的人口统计学和临床特征的数据却很匮乏。本研究的目的是描述一大群NE患者的人口统计学特征、临床特征、合并症、诊断时间、按专科划分的患者转诊来源以及用药情况。我们回顾性分析了2008年至2010年期间确诊的连续性NE病例。对这些患者的电子病历进行了审查，并提取了相关信息。我们共识别出115例NE患者。中位年龄为62岁（范围25 - 87岁），63%为女性。患者在诊断前出现症状的中位时间为24个月（0 - 480个月）。大多数患者就诊于内科会诊医师（42%）或胃肠病学家（35%）。主要症状为胸痛（31%）和吞咽困难（21%）。胃食管反流病（GERD）症状很常见：51%的患者出现烧心，77%有GERD病史，78%正在接受抑酸药物治疗。至少35%的患者经检测确诊为GERD。24%的患者存在精神科合并症，其中一半患者正在接受精神药物治疗。15%的患者同时存在肠易激综合征（IBS），12%的患者同时存在纤维肌痛。令人惊讶的是，26%的患者被开具了阿片类药物。未发现食管动力参数与症状之间存在统计学上的显著相关性。在本研究中，NE患者更常见于中年女性，症状出现至诊断之间的时间较长。许多患者最初因吞咽困难或胸痛由内科医生进行评估，且有GERD病史。诊断前开具的药物通常涉及抑酸，但麻醉药和精神药物的处方也很常用。中枢敏化综合征（纤维肌痛和IBS）、精神科合并症和反流通常同时存在。我们的研究表明，未来的研究应关注GERD和精神障碍在NE中的作用及相互作用。
