Phenotypes of Jackhammer esophagus in patients with typical symptoms of gastroesophageal reflux disease responsive to proton pump inhibitors

Ivan Kristo,Erwin Rieder,Sebastian F Schoppmann,Katrin Schwameis,Matthias Paireder,Svenja Maschke,Alexander Kainz,Gerd Jomrich

doi:10.1038/s41598-018-27756-9

Ivan Kristo, Erwin Rieder + Show 6 more

Open Access

https://doi.org/10.1038/s41598-018-27756-9

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Journal: Scientific Reports	Publication Date: Jul 2, 2018
Citations: 25	License type: open-access

Affiliation: Medical University of Vienna

Abstract

This trial was designed to assess the prevalence and characteristics of Jackhammer esophagus (JE), a novel hypercontractile disorder associated with progression to achalasia and limited outcomes following anti-reflux surgery in patients with typical symptoms of GERD and responsiveness to proton pump inhibitor (PPI) therapy. Consecutive patients, who were referred for surgical therapy because of PPI responsive typical symptoms of GERD, were prospectively assessed between January 2014 and May 2017. Patients diagnosed with JE subsequently underwent rigorous clinical screening including esophagogastroduodenoscopy (EGD), ambulatory pH impedance monitoring off PPI and a PPI trial. Out of 2443 evaluated patients, 37 (1.5%) subjects with a median age of 56.3 (51.6; 65) years were diagnosed with JE and left for final analysis. Extensive testing resulted in 16 (43.2%) GERD positive patients and 5 (13.9%) participants were observed to have an acid hypersensitive esophagus. There were no clinical parameters that differentiated phenotypes of JE. The prevalence of JE in patients with typical symptoms of GERD and response to PPI therapy is low. True GERD was diagnosed in less than half of this selected cohort, indicating the need for objective testing to stratify phenotypes of JE. (NCT03347903)

Highlights

Gastroesophageal reflux disease (GERD) is suggested to be involved in the induction of a novel hypercontractile condition that is not observed in healthy volunteers and was nicknamed Jackhammer esophagus (JE)[1,2]
This is the first study prospectively assessing the prevalence of JE in a selected cohort of patients presumptive of GERD
We could demonstrate that JE was found in 1.7% of patients referred for surgical therapy at a specialized academic centre

Summary

Introduction

Gastroesophageal reflux disease (GERD) is suggested to be involved in the induction of a novel hypercontractile condition that is not observed in healthy volunteers and was nicknamed Jackhammer esophagus (JE)[1,2]. Nutcracker esophagus, a phenotype of hypercontractility that, in contrast to JE, was observed in healthy controls, was associated with adverse postoperative outcomes following laparoscopic anti-reflux surgery[6]. These findings irritate surgical considerations, as implementation of HRM as a mandatory preoperative examination in patients with high evidence of GERD is discussed controversially in literature[7,8,9,10,11]. This trial was designed to assess the prevalence and characteristics of JE in patients presenting with typical symptoms of GERD and therapeutic PPI response, referred for surgical anti-reflux therapy at a specialized centre

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Results

Conclusion