Nutcracker esophagus is characterized as a motility disorder of the esophagus, meaning that it is caused by abnormal movement, or peristalsis of the esophagus.^[1] Patients with motility disorders present with two key symptoms: either with chest pain (typically given termed as non-cardiac chest pain as it is esophageal in origin), which is usually found in disorders of spasm, or with dysphagia, or difficulty swallowing. Nutcracker esophagus can present with either of these, but chest pain is the more common presentation.^[2] The symptoms of nutcracker esophagus are intermittent, and may occur with or without food.^[1] Rarely patients can present with a sudden obstruction of the esophagus after eating food (termed a food bolus obstruction, or the steakhouse syndrome) requiring urgent treatment.^[3][4] The disorder also does not progress to produce worsening symptoms or complications, unlike other motility disorders, such as achalasia, or anatomical abnormalities of the esophagus, such as peptic strictures or esophageal cancer.^[5]

Many patients with nutcracker esophagus do not have any symptoms at all, as esophageal manometry studies done on patients without symptoms may show the same motility findings as nutcracker esophagus.^[1][6]

Nutcracker esophagus may also be associated with the metabolic syndrome,^[7] obesity,^[8] and gastroesophageal reflux disease.^[9] It is uncertain what the effects of treating the underlying conditions will have on improvement of symptoms.^[10] The incidence of nutcracker esophagus in all patients is uncertain.