Jackhammer Esophagus: From Manometric Diagnosis to Clinical Presentation

Abstract

Background. Jackhammer esophagus is a hypercontractile esophageal disorder recently brought to light with the advent of high resolution manometry (HRM). As little is known about its clinical presentation, the aim of this study was to identify the clinical characteristics associated with this new gastrointestinal motility disorder. Methods. A retrospective study was conducted on patients visiting the CHUM’s Gastro-Intestinal Motility Center from January 2015 to December 2017. The HRM diagnoses were collated in a database along with age and sex of every individual. The latest Chicago classification (version 3.0) was used. Among all the patients subjected to HRM, those diagnosed with Jackhammer esophagus were included in the study. Patient charts were reviewed to collect relevant demographic and clinical data. Key Results. A total of 36 patients with Jackhammer esophagus were included (62 ± 13 years age, 89% females). Their main symptoms were dysphagia (72%), pyrosis (42%), retrosternal chest pain (36%), and epigastralgia (33%). Other manometric findings were hypertonia (22%) and/or inadequate relaxation (19%) of the lower esophageal sphincter. Among the 26 patients who had esogastroduodenoscopy, hiatal hernia was seen in 3 patients. Pathological gastroesophageal reflux was found in 4 of the 10 patients investigated by pH-monitoring. Conclusions and Inferences. Jackhammer esophagus represents 3% of the HRM diagnoses in this study, with a significant female preponderance. In more than two-thirds of cases, the clinical presentation of Jackhammer esophagus is dysphagia.

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

“…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…”

“…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]. …”

Is topical lidocaine beneficial before catheter insertion in esophageal manometry and ambulatory pH monitoring?

“…Enough solution (1 mL) was applied to cover the catheter tip. The catheter was then inserted intranasally, and the tests were conducted in standard fashion as previously described …”

“…Patients who underwent EM or apH from January 2017 to June 2018 had a 2% viscous lidocaine hydrochloride solution (Odan Laboratories) applied intranasally (1 mL) by syringe a few (3)(4)(5) minutes before their test. The same solution was also applied to the catheter as both lubrication and as a topical anesthetic.…”

“…The catheter was then inserted intranasally, and the tests were conducted in standard fashion as previously described. 5,6 From June 2018 until January 2019, we ceased all application of topical anesthesia before EM and apH. Instead, these tests were conducted with a water-soluble lubricating jelly (MUKO, Cardinal Health Canada).…”