Jackhammer Esophagus

Abstract

Jackhammer esophagus (JE) is a recently recognized esophageal motility disorder that is characterized by hypercontractile peristalsis. More than 500 cases have been reported in the literature. Among patients referred for esophageal motility disorders, the prevalence of JE ranges from 0.42% to 9%, with most series describing a prevalence of 2% to 4%. Most cases are women (60.5%). The mean reported age of patients with JE is 65.2 years, and patients commonly have dysphagia (62.8%). Reflux symptoms occur in ∼40% of patients, and chest pain affects more than one-third of patients (36.4%). JE is a heterogenous disorder that is associated with several conditions, including obesity, opioid use, lung transplantation, eosinophilic infiltration of the esophagus, neoplasia, and systemic diseases. The cause and pathogenesis remain unknown, but several observations suggest that it is the result of multiple conditions that likely precipitate increased excitation and abnormal inhibition of neuromuscular function. The natural course of JE also is unknown, but progression to achalasia has been observed in a few patients. Treatment is challenging, in part because of the insufficient understanding of the disorder's underlying mechanisms. Various therapeutic modalities have been used, ranging from observation only to pharmacologic and endoscopic interventions (eg, botulinum toxin injection) to peroral endoscopic myotomy. Treatment efficacy remains largely anecdotal and insufficiently studied.

Hypercontractile Esophagus: Clinical and Manometric Features From a Multicenter Korean Cohort

“…6 However, a female predominance has also been reported. 5 The most predominant characteristic of our cohort was the high prevalence of dysphagia (91.3%). According to previous reports, the prevalence of dysphagia is 60-80%.…”

“…These results are lower than those from recent North American countries (3.0-4.0%) and those from France (1.4%). 5 , 6 , 28 , 29 However, this prevalence could be affected by many non-biologic factors such as institutions’ indications for manometry and patients’ accessibility to the test. Thus, the low prevalence of HE in our cohort needs to be interpretated in this background.…”

“…According to previous reports, the prevalence of dysphagia is 60-80%. 5 , 6 , 16 In a summarized review of > 500 cases, 62.8% of patients had dysphagia. 5 When comparing the prevalence of dysphagia in the present study, that of the CC v4.0 group was higher than that of the CC v2.0 group (91.3% vs 66.7%, P = 0.180).…”

“…1 The prevalence of HE among patients undergoing high-resolution manometry (HRM) rages from 0.4% to 9.0%. 5 The varying prevalence stems from the different diagnostic criteria, geographic factors, and small number of samples. According to a recent review, HE in women is more prevalent, occurring in those with a mean age of 65 years.…”

“…According to a recent review, HE in women is more prevalent, occurring in those with a mean age of 65 years. 5 The most common symptom was dysphagia (62.8%). In a recently published French cohort study, dysphagia was also the most common symptom (74.6%).…”