Hypertensive Peristalsis: A Rare Cause of Dysphagia in a Child

CC This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons. org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. A 6-year-old male child presented with history of intermittent dysphagia for soilds and liquids for the past 6 months. The dys-phagia worsened when taking ice creams and frequency of these episodes had increased from once in 15 days to twice in a week over the reported period. He had lost weight of 1 kg over the period of six months. He reported severe chest pain in nearly 25% of episodes. Clinical examination was normal. He underwent esophagogastroduodenoscopy which revealed normal findings (Fig. 1). High-resolution manometry (Fig. 2) showed normal lower esophageal sphincter pressures with high amplitude peri-staltic contractions (mean amplitude 185 mmHg) in 70% of the wet swallows. There were no synchronus contractions and distal contractile integral was less than 5,000. Thus, a diagnosis of hy-pertensive (nutcracker) esophagus was made. The child was started on oral nifedipine during episodes of pain and is presently doing well. Esophageal motor dysphagia is a rare problem in pediatric age group. Achalsia cardia is the most common etiology. 1 " Nutcracker esophagus " is a term coined by Richter et al 2 for the condition in which patients with non-cardiac chest pain and/or dysphagia exhibit peristaltic waves in the distal esophagus with mean amplitudes exceeding normal values by > 2 SD. The manometric features may vary with time and some patients may develop achalasia. The place of nutcracker esophagus in spectrum of esophageal motility disorders needs further classification. 1 To conclude, Nutcracker esophagus is a rare cause of esoph-ageal dysmotility in pediatric population. High index of suspicion