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

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.

Section: Resultsmentioning

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]. …”

mentioning

confidence: 99%

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

Wahba

Bouin

2020

“…However, few studies report on impedance‐based bolus transit in HE. A single‐center study by Sloan et al reported successful liquid and viscous bolus transit in 15 out of 17 patients (88%) patients with hypercontractility 26 . It could be questioned whether hypercontractility represents an augmented contractile response to facilitate bolus transit.…”

Section: Resultsmentioning

confidence: 99%

Chicago Classification Update (v4.0): Technical review on diagnostic criteria for hypercontractile esophagus

Chen

Savarino

Smout

et al. 2021

Hypercontractile esophagus (HE), defined by the Chicago Classification version 3.0 (CCv3.0) as 20% or more hypercontractile peristalsis (Distal Contractile Integral >8000 mmHg•s•cm) on high-resolution manometry (HRM), is a heterogeneous disorder with variable clinical presentations and natural course, leading to management challenges. An update on the diagnostic criteria for clinically relevant HE was needed.Literature on HE was extensively reviewed by the HE subgroup of the Chicago Classification version 4.0 (CCv4.0) Working Group and statements relating to the diagnosis of HE were ranked according to the RAND UCLA Appropriateness methodology by the Working Group, and the quality of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework.An overall emphasis of the CCv4.0 is on clinically relevant esophageal dysmotility, and thus it is recommended that an HE diagnosis requires both conclusive manometric diagnosis and clinically relevant symptoms of dysphagia and non-cardiac chest pain.The Working Group also recognized the subtypes of HE, including single-peaked, multi-peaked contractions (Jackhammer esophagus), and hypercontractile lower esophageal sphincter. However, there are no compelling data currently for formally subdividing HE to these subgroups in clinical practice. K E Y W O R D SChicago Classification, dysphagia, hypercontractile esophagus, jackhammer esophagus, noncardiac chest pain How to cite this article: Chen JW, Savarino E, Smout A, et al.Chicago Classification Update (v4.0): Technical review on diagnostic criteria for hypercontractile esophagus.

“…For this reason, various studies have attempted to link higher contraction vigor to more frequent or more severe symptoms (both dysphagia and chest pain). 13,25,26 For instance, a study carried out with conventional manometry evaluating the relationship between contraction amplitudes and pain perception threshold on balloon distension studies demonstrated that the higher the contraction amplitudes, the lower the pain perception threshold, and the higher the pain perception. 27 In the cohort study by Philonenko et al 6 published in this issue, the subgroup of patients who complained of dysphagia had a slightly but significantly higher median DCI than the subgroup who did not have dysphagia (11,802 vs 10,667 mmHg•cm•s).…”

Section: A Ssociation With Symp Tomsmentioning

confidence: 99%

“…To accept a cause–effect relationship, a correlation between contractile vigor and presence or severity of dysphagia would help. For this reason, various studies have attempted to link higher contraction vigor to more frequent or more severe symptoms (both dysphagia and chest pain) 13,25,26 . For instance, a study carried out with conventional manometry evaluating the relationship between contraction amplitudes and pain perception threshold on balloon distension studies demonstrated that the higher the contraction amplitudes, the lower the pain perception threshold, and the higher the pain perception 27 .…”

Section: Association With Symptomsmentioning

confidence: 99%

The hypercontractile esophagus: Still a tough nut to crack

Savarino

Smout

2020