He's 11 years old. Patients that have had one or more previous antireflux operations with recurrent symptoms or problems represent a challenging group of patients, and really should be evaluated and cared for by physicians who have dedicated themselves to the study of reflux disease. Most likely his options of repeat antireflux surgery have run out. And he's likely looking at some type of reconstruction and resection. There are a number of risk factors associated with more severe reflux disease that can tip us off that the patient may have a higher risk of failure.
Nutcracker esophagus is a description of an esophagus that has very strong contractions.
The ideology or cause of nutcracker esophagus is not known with certainty. But the irritation of reflux disease may lead to nutcracker esophagus in some patients. Consequently, the elimination of the reflux with the operation may also eliminate the problem with the nutcracker esophagus. The Barrett's esophagus, which is a prerequisite to developing esophageal adenocarcinoma, can be adequately examined with an endoscope after antireflux surgery. If anything, evidence would suggest that an antireflux operation makes the development of cancer less likely to occur in patients with reflux disease and Barrett's esophagus.