In nutcracker esophagus there are high pressure peristaltic waves. The patient may complain of chest pain. This pain may sometimes be due to a episode of prolonged, high amplitude contraction or spasm of the esophageal muscle. A 24 hour ambulatory esophageal manometry will sometimes point to the esophagus as the cause of the pain and thus eliminate other more serious causes.
There is some suggestion that the nutcracker esophagus may preceed diffuse esophageal spasm. Investigators have noted that patients with the nutcracker esophagus have more bizarre contractions and non-isobaric simultaneous esophageal contractions than normal people.