Dysphagia severity is related to the amplitude of distal contractile integral in patients with Jackhammer esophagus

Kristo, Ivan; Schwameis, Katrin; Paireder, Matthias; Jomrich, Gerd; Kainz, Alexander; Schoppmann, Sebastian F.

doi:10.1111/nmo.13276

Cited by 21 publications

(44 citation statements)

References 29 publications

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“…Therefore, a therapeutic approach like peroral endoscopic myotomy is regarded as suitable treatment in these individuals [24]. Confirmatory, our group emphasized that JE is of progressive clinical nature and may even mimic GERD by responding to PPI therapy [15,25]. It is obvious that these facts influence bariatric strategies or even limit postoperative outcomes after surgery.…”

Section: Discussionmentioning

confidence: 83%

“…High-resolution impedance manometry was performed using a solid-state catheter with 32 circumferential pressure transducers at 1-cm intervals and dual impedance sensors (Sandhill Scientific, Highlands Ranch, CO, USA) as previously described [15]. Esophageal body motility was assessed with 10 liquid swallows of 5 ml at 30-s intervals.…”

Section: High-resolution Impedance Manometrymentioning

confidence: 99%

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Modern Esophageal Function Testing and Gastroesophageal Reflux Disease in Morbidly Obese Patients

et al. 2019

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Background The implementation of high-resolution manometry (HRM) and the Lyon Consensus statement facilitate evaluation of gastroesophageal reflux disease and motility disorders in morbidly obese patients. Therefore, we aimed to investigate prevalence and phenotype of (borderline) GERD and esophageal motility disorders in this population. Methods Consecutive morbidly obese (BMI ≥ 35 kg/m 2 ) patients were offered evaluation by means of HRM, ambulatory 24-h pH impedance monitoring, endoscopy, and a clinical examination at our tertiary academic center. Data were collected prospectively.Results Out of 448 eligible individuals, 147 patients (females = 75, 51%) with a median age of 41.6 (33.4; 52.3) years and a BMI of 44 (40.9; 49.4) kg/m 2 were included during the study period. The Chicago Classification revealed motility disorders in 50 (34%) patients, dominated by outflow obstruction (18.4%, n = 27) and a novel disorder (7.5%, n = 11), nicknamed jackhammer esophagus (JE). According to the Lyon Consensus, 52 (35.4%) patients had evidence of true GERD, whereas borderline GERD was noted in another 60 (40.8%). Hypersensitive esophagus was observed in 6.8% (n = 10). Sensitivity and specificity of symptoms for GERD were 53.8% and 68.4%, respectively. Conclusions The current gold standard of assessment revealed that the prevalence of esophageal motility disorders and (borderline) GERD is high in the morbidly obese population. Further longitudinal data are needed to delineate the natural course of novel motility disorders like JE in obesity and to identify risk factors for adverse outcomes following bariatric surgery.

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Section: Discussionmentioning

confidence: 83%

Section: High-resolution Impedance Manometrymentioning

confidence: 99%

Modern Esophageal Function Testing and Gastroesophageal Reflux Disease in Morbidly Obese Patients

et al. 2019

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“…Diagnoses of JE comprised 1.97% [95% CI: 1.39%-2.78%; Cochran's Q = 81.7, I 2 = 87.8%] of HRM studies based on eleven studies reporting this data in unselected symptomatic individuals referred for HRM [16][17][18][19][20][21][22][23][24][25][26] ( Figure 2). On sensitivity analysis, we found that Zuluaga…”

Section: Demographicsmentioning

confidence: 99%

Jackhammer esophagus: A meta‐analysis of patient demographics, disease presentation, high‐resolution manometry data, and treatment outcomes

Wahba

Bouin

2020

Neurogastroenterology Motil

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Background: Jackhammer esophagus (JE) is a newly described esophageal motility disorder. However, there are limited data on JE and this entity remains misunderstood. Methods: We performed a systematic review of clinical series on JE through MEDLINE, EMBASE, and Web of Science. Data from included studies were then extracted, and random-effects meta-analyses were performed. Results: Thirty-eight studies met inclusion criteria. The pooled prevalence of JE was 1.97% [95% CI: 1.39%-2.78%] among patients referred for high-resolution manometry (HRM). The mean age at diagnosis was 60.8 years [95% CI: 57.1-64.4] and 65% [95% CI: 58%-72%] of patients were female. JE was significantly more prevalent in postlung transplant patients and morbidly obese patients undergoing HRM (23.99% [95% CI: 9.00%-38.97%] and 5.18% [95% CI: 1.76%-14.3%] respectively). Dysphagia was the most common presentation of JE (64% [95% CI: 52%-77%]) followed by gastroesophageal reflux disease (46% [95% CI: 26%-67%]). The pooled mean distal contractile integral (DCI) of all standard HRM swallows was 9249 mm Hg•s•cm [95% CI: 7834-10 663], and the pooled mean integrated relaxation pressure (IRP) was 13.9 mm Hg [95% CI: 8.2-19.7]. Overall, 73.6% [95% CI: 64.0%-83.1%] of JE patients who underwent treatment achieved clinical symptom improvement (79% [95% CI: 74%-85%] for endoscopic treatment and 63% [95% CI: 47%-79%] for medical treatment). The pooled clinical success rate of peroral endoscopic myotomy (POEM) specifically was 82% [95% CI: 75%-90%]. Conclusions: JE is a new motility disorder most commonly presenting with dysphagia. High clinical suspicion is important because the diagnosis can only be made through HRM.

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“…The negative outcome of this study can be interpreted in two ways. The authors concluded that the study was negative because hypercontractile esophageal motility disorders have a benign natural disease course, with spontaneous improvement after three months in line with some but not all previous reports . Another interpretation could be that patients with hypercontractile esophageal motility disorders have functional esophageal symptoms that are not related to the esophageal hypercontractility, and therefore, these symptoms are not responding to treatment of the hypercontractility.…”

mentioning

confidence: 55%

“…The authors concluded that the study was negative because hypercontractile esophageal motility disorders have a benign natural disease course, with spontaneous improvement after three months in line with some but not all previous reports. [3][4][5][6] Another interpretation could be that patients While pooled together in this study, type III achalasia is probably different from jackhammer and DES, as the relationship between symptoms and abnormal motility seems clearer in type III achalasia and more data on natural history and development to other types of achalasia is available. For DES and jackhammer, a substantial subset of these patients may have functional symptoms that therefore do not respond to reduction of hypercontractility with botulinum toxin.…”

mentioning

confidence: 90%

Hypercontractile esophageal motility disorder or functional esophageal symptoms and unrelated hypercontractility?

Bredenoord

2019

Neurogastroenterology Motil

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In this issue of the journal, Mion and coworkers describe 23 patients with dysphagia and/or thoracic pain and hypercontractile esophageal motility disorders who were either treated with botulinum toxin 100 U or underwent a sham procedure. The surprising outcome of the study was that both active botulinum toxin treatment and sham treatment resulted in a significant reduction in symptoms and manometric abnormalities after 3 months, with no difference between the two arms. One can interpret the lack of effect of botulinum toxin over placebo as indicative of the benign natural history of hypercontractile esophageal motility disorders or be convinced that many patients with hypercontractility on manometry actually have functional symptoms not related to the manometric findings, and thus, treatment of hypercontractility is not more effective than placebo. Either way, invasive, irreversible treatments with potential risks for complications seem difficult to justify in these patients.

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Dysphagia severity is related to the amplitude of distal contractile integral in patients with Jackhammer esophagus

Abstract: The DCI mediates dysphagia in patients with JE. Duration of symptoms affected hypercontractile DCI scores and aggravated perception of dysphagia indicating a progressive character of disease.

Cited by 21 publications

References 29 publications

Modern Esophageal Function Testing and Gastroesophageal Reflux Disease in Morbidly Obese Patients

Modern Esophageal Function Testing and Gastroesophageal Reflux Disease in Morbidly Obese Patients

Jackhammer esophagus: A meta‐analysis of patient demographics, disease presentation, high‐resolution manometry data, and treatment outcomes

Hypercontractile esophageal motility disorder or functional esophageal symptoms and unrelated hypercontractility?

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