Nutcracker esophagus is a benign, non-progressive condition, meaning that it is not associated with significant complications. Patients are usually reassured by their physicians that the disease is not associated with worsening. However, the symptoms of chest pain and dysphagia may be severe enough to require treatment with medications, and, rarely, surgery.

The first step in treatment of nutcracker esophagus is the reduction of risk factors. While weight reduction may be useful in reducing symptoms, the role of acid suppression therapy to reduce esophageal reflux, is still uncertain.^[1]

Medical therapy for nutcracker esophagus includes the use of calcium-channel blockers, which relax the LES and palliate the dysphagia symptoms. Diltiazem has been used in randomized control studies with good effect.^[2] Nitrate medications, including isosorbide dinitrate, given before meals may also help relax the LES and improve symptoms.^[3] Phosphodiesterase inhibitors, such as sildenafil have also been tried in case series for treatment.^[3] Finally, trazodone, an anti-depressant that reduces visceral sensitivity, has also been shown to reduce chest pain symptoms in patients with nutcracker esophagus.^[3][4][5]

Endoscopic therapy with botulinum toxin, known also as Botox, can also be used to temporarily improve symptoms,^[6] but the effect is temporarily and may only last for weeks.