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

Abstract

Introduction: Jackhammer Esophagus defined as intact esophageal peristaltic contractions with extremely elevated amplitudes. We conducted a retrospective study to identify the frequency of esophageal hypercontractility and the clinical characteristics of Jackhammer Esophagus. Methods: Charts for the patients referred for manometric study at a tertiary-care motility center were reviewed. Data were collected utilizing the new Chicago classification criteria for Jackhammer Esophagus. Concomitant clinical variables were also explored. Results: From a total of 205 patients (127 F/77 M), 8 patients met criteria for Jackhammer Esophagus from a total of. Jackhammer patients had an average distal contractile integral (DCI) of 9,061 mm Hg-sec-cm and median maximal DCI of 16,433 mm Hg-sec-cm. The greatest DCI from 15 swallows was 28,875 mm Hg-sec-cm. Hypercontractility was associated with multipeaked contractions in every Jackhammer patient. The mean lower esophageal sphincter (LES) pressure was 41 mmHg (4 patients > 40). 37.5% of Jackhammer group had incomplete LES relaxation by Integrated Relaxation Pressure (IRP) criteria. Dysphagia (8/8) was the dominant indication for the manometric study, while the clinical background setting was gastroesophageal reflux disease (4/8) and hiatal hernia (1/8). Treatments included smooth muscle relaxation, anti-reflux regiments, and pneumatic dilation of the LES. Conclusion: 1) Jackhammer Esophagus, an extreme manometric phenotype, was identified in 4.0% of patients referred to a University Motility Center; 2) The patients with these esophageal hypercontractility states present mainly with dysphagia; 3) a subgroup of Jackhammer did have accompanying incomplete LES relaxation and responded to a targeted therapeutic with pneumatic dilatation.