Nitrate medications, including isosorbide dinitrate, given before meals, may also help relax the LES and improve symptoms. The inexpensive generic combination of belladonna and phenobarbital (Donnatal and other brands) may be taken three times daily as a tablet to prevent attacks or, for patients with only occasional episodes, as an elixir at the onset of symptoms. Phosphodiesterase inhibitors, such as sildenafil, can be given to reduce symptoms, particularly pain, but small trials have not been able to demonstrate clinical improvement. Procedures
Endoscopic therapy with botulinum toxin can also be used to improve dysphagia which stabilizes unintentional weight loss, but the effect has limited effect on other symptoms, including pain, while also being a temporary treatment lasting a few weeks. Finally, pneumatic dilatation of the esophagus, which is an endoscopic technique where a high-pressure balloon is used to stretch the muscles of the LES, can be performed to improve symptoms, but again no clinical improvement is seen in regards to motility.In people who have no response to medical or endoscopic therapy, surgery can be performed. A Heller myotomy involves an incision to disrupt the LES and the myenteric plexus that innervates it. The Heller myotomy is used as a final treatment option in patients who do not respond to other therapies. Prognosis
Nutcracker esophagus is a benign, nonprogressive condition, meaning it is not associated with significant complications. See also
Esophageal spasm

References


== External links ==
This gene mediates chloride and bicarbonate exchange and additionally transports sulfate and other anions at the apical membrane, part of the plasma membrane of enterocytes. It is also known that related phenotypes are  Increased shRNA abundance (Z-score > 2). Diagnosis
Tenonitis can be identified and diagnosed a few different ways. Tenons capsule may have inflammation from a disease called idiopathic orbital inflammation syndrome. There is no history of trauma or adjacent focus of infection with this disease. In order to diagnose tenonitis some type of imaging is needed, such as a CT or MRI. The imaging is used to capture the inflammation and to spot any possible chance of infection. For chronic diseases a biopsy may be needed to determine an underlying condition that may be causing the recurring inflammation. Treatment
The main course of treatment for this specific disease would be to surgically excise the capsule. There is no info that implies the inflammation of this capsule will go down over time so the known course of action would be to have it surgically removed in order to relieve discomfort and to prevent further irritation to this area. Prognosis
Although this may not be a lethal disease, it will progressively get worse over time. Depending on the severity of the disease, this may have months of progression. When going past 3 months of having issues, the main course of action would be to surgically relieve the pain or total excision of the affected area. Epidemiology
This disease has no specific population it targets more.