Hypercontractile Esophagus: An Underrecognized Cause of Dysphagia with a "Nutcracker" Appearance on Barium Esophagram.

Authors

David K A Donkor, Oluchi Idenyi, Cinna Attar, Emmanuel Gbadehan

Published in

Journal of Brown hospital medicine. Volume 5. Issue 3. Pages 163429. Epub Jul 01, 2026.

Abstract

Esophageal motility disorders are an important and uncommon cause of dysphagia when structural abnormalities are absent. We present a case of a 77-year-old woman with dysphagia and regurgitation whose barium esophagram demonstrated a characteristic "nutcracker" appearance of the distal esophagus. Despite this striking radiographic finding, peristalsis was preserved, and a barium tablet traversed the segment without obstruction. These features argue against classic diffuse esophageal spasm and instead suggest a hypercontractile motility disorder. This case highlights the role of barium esophagram as a complementary diagnostic tool while emphasizing that definitive classification of esophageal motility disorders requires high-resolution manometry.

PMID:
42405375
Bibliographic data and abstract were imported from PubMed on 06 Jul 2026.

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