Nonpropulsive esophageal contractions radiologically described as tertiary 
contractions or "corkscrew" esophagus suggest the presence of an underlying 
motility disorder and may lead to impaired acid clearance. The goals of this 
study were to determine the prevalence and role of gastroesophageal reflux (GER) 
in patients with tertiary contractions. Thirty-five consecutive patients with 
spontaneous, repetitive, nonpropulsive esophageal contractions noted on 
esophagography were studied with endoscopy, infusion esophageal manometry, and 
24-h ambulatory pH monitoring. All patients had esophageal symptoms, mainly 
dysphagia, heartburn, and chest pain, but only three were found to have 
esophagitis by endoscopy and biopsy. Nineteen patients had repetitive, 
nonlumen-obliterating, nonperistaltic (tertiary) contractions, six had corkscrew 
esophagus, and 10 had forceful, lumen-obliterating simultaneous contractions 
(rosary bead esophagus). Twenty patients (58%) had GER by pH criteria with mean 
values: % time pH less than 4, 40.9; %upright pH less than 4, 41; %supine pH 
less than 4, 44.3%; number of episodes with greater than 5 min of pH less than 
4, 12. Esophageal motility revealed "nutcracker" esophagus in eight, low LESP in 
two, and nonspecific esophageal motility disorder in 10. Symptoms or severity of 
nonperistaltic contractions did not correlate with GER. Radiologically 
demonstrable free reflux or the presence of heartburn did not predict GER. We 
conclude that 1) GER occurs in up to 58% of patients with nonpropulsive 
(tertiary) esophageal contractions on esophagography, and may play a role in the 
induction of abnormal peristaltic activity of the esophageal body; 2) GER is 
usually not associated with endoscopic evidence of esophagitis or characteristic 
symptoms, and is recognized by 24-h pH monitoring. We speculate that detection 
and treatment of GER may improve the symptomatic management of patients with 
nonpropulsive esophageal contractions.