Jackhammer Esophagus: Symptom Presentation, Associated Distal Contractile Integral, and Assessment of Bolus Transit

Joshua Sloan, Ramzi Mulki, Naemat Sandhu, Solomon Samuel, Philip O. Katz

Research output: Contribution to journalArticle

Abstract

Goals: The aim of our study was to characterize jackhammer esophagus symptoms and their relationship with the distal contractile integral (DCI) and bolus transit. Background: Jackhammer esophagus is defined by the Chicago Classification version 3.0. This diagnosis is relatively new, with the most current definition being established in 2014. The forerunners of this diagnosis, nutcracker (or hypercontractile) esophagus, have been associated with noncardiac chest pain (NCCP). Study: A retrospective chart review was performed of motility studies from 2011 to 2016. Studies with a diagnosis of jackhammer esophagus, hypercontractile esophagus, nutcracker, esophagogastric junction outflow obstruction, or hypertensive lower esophageal sphincter were reread using Chicago Classification version 3.0, and were included if they met criteria for jackhammer esophagus. Unpaired t-tests were used for analysis (P≤0.05). Results: In total, 142 studies were identified with the above diagnoses. After excluding 84 studies, 58 remained for analysis and 17 were found to have jackhammer esophagus (29%). The mean age was 54 (28 to 75), 5 (29%) were males and 12 (71%) were females. The primary indications were NCCP (5), dysphagia (8), and other causes (4) (cough, heartburn, or regurgitation). The mean DCIs were 17,245 mm Hg×s×cm (NCCP), 14,669 mm Hg×s×cm (dysphagia), and 11,264 mm Hg×s×cm (other causes). The mean DCIs were compared: NCCP versus dysphagia (P=0.41), and NCCP versus other causes (P=0.05). Fifteen (88%) had normal bolus transit for both liquid and viscous swallows. Conclusions: In our small sample size, dysphagia was frequently the presenting symptom followed by NCCP. Those with NCCP have a trend toward a higher DCI. Bolus transit appeared to be normal in this patient population. More data are needed to further elucidate the genesis of symptoms and how they relate to the degree of contractility.

Original languageEnglish (US)
Pages (from-to)295-297
Number of pages3
JournalJournal of clinical gastroenterology
Volume53
Issue number4
DOIs
StatePublished - Apr 1 2019
Externally publishedYes

Fingerprint

Chest Pain
Esophagus
Deglutition Disorders
Esophageal Motility Disorders
Swallows
Esophagogastric Junction
Heartburn
Lower Esophageal Sphincter
Cough
Sample Size
Retrospective Studies
Population

Keywords

  • chest pain
  • dysphagia
  • esophageal dysmotility
  • high-resolution manometry
  • impedance

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Jackhammer Esophagus : Symptom Presentation, Associated Distal Contractile Integral, and Assessment of Bolus Transit. / Sloan, Joshua; Mulki, Ramzi; Sandhu, Naemat; Samuel, Solomon; Katz, Philip O.

In: Journal of clinical gastroenterology, Vol. 53, No. 4, 01.04.2019, p. 295-297.

Research output: Contribution to journalArticle

Sloan, Joshua ; Mulki, Ramzi ; Sandhu, Naemat ; Samuel, Solomon ; Katz, Philip O. / Jackhammer Esophagus : Symptom Presentation, Associated Distal Contractile Integral, and Assessment of Bolus Transit. In: Journal of clinical gastroenterology. 2019 ; Vol. 53, No. 4. pp. 295-297.
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