Frequency of Jackhammer Esophagus as the Extreme Phenotypes of Esophageal Hypercontractility Based on the New Chicago Classification

Jia, Yi; Arenas, Juan; Hejazi, Reza; Elhanafi, Sherif; Saadi, M.; McCallum, Richard W.

doi:10.14309/00000434-201510001-01668

Cited by 5 publications

(21 citation statements)

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“…3,7,8 As in other studies, the most commonly reported symptom was dysphagia, followed by chest pain and GERD symptoms, and more than half of our patients reported multiple symptoms. 3,[8][9][10] The impact of symptoms ranged from patients with few or no symptoms to patients describing anorexia and substantial weight loss. Approximately one-fifth of patients had a sudden onset of symptoms, leading to a major and rapid clinical deterioration that brought them to an early consultation, while a large majority (79.7%)…”

Section: Ta B L E 1 High-resolution Manometry Parameters In All 232 Pmentioning

confidence: 99%

Jackhammer esophagus: Clinical presentation, manometric diagnosis, and therapeutic results—Results from a multicenter French cohort

Philonenko

Roman

Zerbib

et al. 2020

Neurogastroenterology Motil

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Background/aims: Jackhammer esophagus (JE) is a hypercontractile esophageal motor disorder defined by at least two swallows with a distal contractile integral (DCI) >8000 mm Hg.s.cm during high-resolution manometry (HRM). The relationship between symptoms and hypercontractility and the response to therapies have been poorly evaluated. The aim of this study was to determine the clinical presentation, manometric diagnosis, and therapeutic results in a large cohort of JE patients. Methods: Patients with JE diagnosed among the HRM tests performed in nine academic French centers from 01/01/2010 to 08/31/2016 were included. Patient charts were reviewed to collect clinical and therapeutic data. Results: Among the 16 264 HRM tests performed during this period, 227 patients (60.8 ± 13.8 years, 151 male) had JE (1.7%). Dysphagia was the most frequent symptom (74.6%), followed by regurgitation (37.1%) and chest pain (36.6%); 4.7% of the patients were asymptomatic. The diagnostic workup was heterogeneous, and only a minority of patients had esophageal biopsies. None of the individual symptoms were significantly associated with any of the manometric parameters defined, except for dysphagia, which was significantly associated with the mean of all DCIs >8000 mm Hg.s.cm (P = .04). Additionally, the number of symptoms was not associated with any manometric parameter. Medical treatment and endoscopic treatments had poor efficacy and a high relapse rate. Conclusion: Jackhammer esophagus is a rare motility disorder. Diagnostic workup is heterogeneous and should be standardized. Symptoms are poorly associated with manometric parameters. The medical treatments and endoscopic therapies currently used are inefficient.

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Section: Ta B L E 1 High-resolution Manometry Parameters In All 232 Pmentioning

confidence: 99%

Jackhammer esophagus: Clinical presentation, manometric diagnosis, and therapeutic results—Results from a multicenter French cohort

Philonenko

Roman

Zerbib

et al. 2020

Neurogastroenterology Motil

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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%

“…The mean pooled age of patients diagnosed with JE was 60.8 years [95% CI: 57.1-64.4; Cochran's Q = 51.2, I 2 = 84.4%], 16,20-22,25,27-30 and 64.9% of diagnosed patients were female [95% CI: 57.7%-72.1%; Cochran's Q = 42.6, I 2 = 71.8%] 16,[20][21][22][23]25,26,[28][29][30][31][32][33]. …”

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confidence: 99%

“…The most frequently reported symptom in patients diagnosed with JE was dysphagia (64.1% of patients The diagnosis of JE ultimately relies on the recorded DCI during HRM. We found that in patients with JE, the pooled mean DCI of all swallows in a standard HRM study was 9,248.6 mm Hg•s•cm [95% CI: 7834.1-10 663.2; Cochran's Q = 143.3, I 2 = 96.5%] [20][21][22]25,30,48. There were other methods of reporting DCI among patients diagnosed with JE, such as the mean maximal DCI, but these were not sufficiently frequently reported to be pooled.…”

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confidence: 99%

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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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“…Jackhammer esophagus (JE) is a relatively rare diagnosis appearing in only 4% of patients referred to a tertiary center for esophageal motility testing. 1,2 Although dysphagia and chest pain are common in JE patients, dysphagia has been demonstrated to correlate with contractile vigor. 3 The pathophysiology of jackhammer contractions is poorly understood, but multiple theories have been proposed.…”

Section: Introductionmentioning

confidence: 99%

Gastroesophageal Reflux Disease Is Not Associated With Jackhammer Esophagus: A Case-control Study

Woo

Liu

Wilsack

et al. 2020

J Neurogastroenterol Motil

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Background/Aims The pathophysiology of jackhammer esophagus (JE) remains unknown but may be related to gastroesophageal reflux disease or medication use. We aim to determine if pathologic acid exposure or the use of specific classes of medications (based on the mechanism of action) is associated with JE. Methods High-resolution manometry (HRM) studies from November 2013 to March 2019 with a diagnosis of JE were identified and compared to symptomatic control patients with normal HRM. Esophageal acid exposure and medication use were compared between groups. Multivariate regression analysis was performed to look for predictors of mean distal contractile integral. Results Forty-two JE and 127 control patients were included in the study. Twenty-two (52%) JE and 82 (65%) control patients underwent both HRM and ambulatory pH monitoring. Two (9%) JE patients and 14 (17%) of controls had evidence of abnormal acid exposure (DeMeester score > 14.7); this difference was not significant (P = 0.290). Thirty-six (86%) JE and 127 (100%) control patients had complete medication lists. Significantly more JE patients were on long-acting beta agonists (LABA) (JE = 5, control = 4; P = 0.026) and calcium channel blockers (CCB)

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Frequency of Jackhammer Esophagus as the Extreme Phenotypes of Esophageal Hypercontractility Based on the New Chicago Classification

Cited by 5 publications

References 0 publications

Jackhammer esophagus: Clinical presentation, manometric diagnosis, and therapeutic results—Results from a multicenter French cohort

Jackhammer esophagus: Clinical presentation, manometric diagnosis, and therapeutic results—Results from a multicenter French cohort

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

Gastroesophageal Reflux Disease Is Not Associated With Jackhammer Esophagus: A Case-control Study

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