Hypercontractile Esophagus: An Underrecognized Cause of Dysphagia with a “Nutcracker” Appearance on Barium Esophagram

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.