ABSTRACT
Objective@#To evaluate the prevalence and characteristics of Jackhammer esophagus (JE).@*Methods@#From December 2015 to December 2018, the clinical data of 20 patients with JE in the People's Hospital of Yuhuan were retrospectively analyzed.The clinical data of JE patients with typical symptoms of proton pump inhibitor reactive gastroesophageal reflux disease (GERD) were evaluated.The differences between JE patients with or without GERD or allergic esophagus were analyzed, which including esophagogastroscopy (EGD), dynamic pH impedance monitoring of proton pump inhibitors and proton pump inhibitor tests.@*Results@#Of 20 patients with JE, the average age was (55.86±3.23) years old, and BMI was (26.10±3.21)kg/m2.Among JE patients, 10 cases (50.0%) were GERD positive, 2 cases (10.0%) were acid sensitive esophagus, and 8 cases (40.0%) were GERD negative.There were no statistically significant differences in heartburn (P=0.167), nausea (P=0.250), dysphagia (P=0.714) or non-cardiac chest pain (P=0.906) and their duration (P=0.319) among the three types of patients.It also affected the intake of proton pump inhibitor (P=0.377) and heartburn (P=0.494). The total number of reflux in patients with positive GERD caused by JE proton pump inhibitor was significantly increased (P=0.027).@*Conclusion@#JE has a low prevalence rate in patients with typical symptoms of GERD and proton pump inhibitor treatment response.In this study, only nearly half of the people were diagnosed as GERD positive, which indicates that additional objective tests are needed to stratify JE phenotypes.
ABSTRACT
El esófago en martillo neumático (Jackhammer) es un trastorno peristáltico de hipercontractilidad, que de acuerdo con la clasificación de Chicago v.2 se define manométricamente como la presencia de una onda de amplitud y velocidad alta; es decir, con una integral de contractibilidad distal (ICD) superior a 8000 mm Hg/cm/s. Presentamos una serie de cinco pacientes con esófago en martillo neumático que fueron estudiados con manometría esofágica de alta resolución (MAR); recopilamos sus variables clínicas y manométricas. Los casos correspondieron a tres hombres y dos mujeres entre 41 y 73 años de edad. En 3 de ellos se había realizado el diagnóstico de enfermedad por reflujo gastroesofágico, y presentaban síntomas de disfagia, pirosis y regurgitación. El principal hallazgo endoscópico fue la presencia de una hernia hiatal y presbiesófago (2 de 5 pacientes). En todos ellos se realizó MAR que demostró la presencia de una y hasta 4 ondas con ICD superior a 8000 mm Hg/cm/s. Además, la presencia de ondas multipico en 3 de los 5 pacientes, aunque, de acuerdo con la nueva clasificación de Chicago v.3, se requiere la presencia de dos ondas con ICD superior a 8.000 mm Hg/cm/s. Se debe resaltar que aún no se cuenta con equipos disponibles que interpreten a MAR y permitan clasificar los trastornos esofágicos por Chicago v.3, y es por esto que en nuestra unidad de fisiología aún reportamos la MAR con la clasificación previa. Concluimos que el esófago en martillo neumático es una patología con clínica variada que va desde disfagia y dolor torácico hasta síntomas por ERGE, cuyo diagnóstico debe ser confirmado por MAR
Jackhammer esophagus is a peristaltic hypercontractile disorder. According to the second version of the Chicago Classification of esophageal motility, jackhammer esophagus is defined manometrically by distal contractile integrals greater than 8000 mm Hg/cm/s which indicates very high amplitude and velocity. We present a series of five patients with jackhammer esophagus who underwent high-resolution esophageal manometry (HREM) from which clinical and manometric data were collected. There were three men and two women whose ages ranged from 41 to 73. Three of them had been diagnosed with gastroesophageal reflux disease, and showed symptoms of dysphagia, heartburn and regurgitation. The main endoscopic finding was the presence of hiatal hernia and presbyesophagus in two patients. HREM showed waves of up to 4 mm Hg greater than 8000 mm Hg/cm/s. In three of the five patients there were multiple waves. Although, the new third version of the Chicago classification of requires two waves with DCIs over 8000 mm Hg/cm/s to confirm a diagnosis of jackhammer esophagus, it should be noted that we do not yet have available equipment to interpret MAR and allow classifying esophageal disorders by Chicago v.3, and that is why in our physiology unit we still report the MAR with presorting. We conclude that the jackhammer esophagus is a disease with a varied clinical presentation that ranges from dysphagia and chest pain to GERD symptoms. Diagnosis must be confirmed by HREM
Subject(s)
Humans , Male , Female , Adult , Esophageal Diseases , ManometryABSTRACT
Radiofrequency catheter ablation (RFCA) is a potentially curative method for treatment of highly symptomatic and drug-refractory atrial fibrillation (AF). However, this technique can provoke esophageal and nerve lesion, due to thermal injury. To our knowledge, there have been no reported cases of a newly described motor disorder, the Jackhammer esophagus (JE) after RFCA, independently of GERD. We report a case of JE diagnosed by high-resolution manometry (HRM), in whom esophageal symptoms developed 2 weeks after RFCA, in absence of objective evidence of GERD. A 65-year-old male with highly symptomatic, drug-refractory paroxysmal AF was candidate to complete electrical pulmonary vein isolation with RFCA. Prior the procedure, the patient underwent HRM and impedance-pH to rule out GERD or hiatal hernia presence. All HRM parameters, according to Chicago classification, were within normal limits. No significant gastroesophageal reflux was documented at impedance pH monitoring. Patient underwent RFCA with electrical disconnection of pulmonary vein. After two weeks, patient started to complain of dysphagia for solids, with acute chest-pain. The patient repeated HRM and impedance-pH monitoring 8 weeks after RFCA. HRM showed in all liquid swallows the typical spastic hypercontractile contractions consistent with the diagnosis of JE, whereas impedance-pH monitoring resulted again negative for GERD. Esophageal dysmotility can represent a possible complication of RFCA for AF, probably due to a vagal nerve injury, and dysphagia appearance after this procedure must be timely investigated by HRM.
Subject(s)
Aged , Humans , Male , Atrial Fibrillation , Catheter Ablation , Classification , Deglutition Disorders , Diagnosis , Electric Impedance , Esophageal Motility Disorders , Esophagus , Gastroesophageal Reflux , Hernia, Hiatal , Hydrogen-Ion Concentration , Manometry , Muscle Spasticity , Pulmonary Veins , Swallows , Vagus Nerve StimulationABSTRACT
A 49-year-old woman visited our hospital with dysphagia and chest pain. In another hospital, she was diagnosed as reflux esophagitis. Although she had taken proton pump inhibitor and prokinetics drugs for a long time, she was not relieved of any symptoms. On the basis of high resolution manometry and endoscopic ultrasonography findings, Jackhammer esophagus was diagnosed. In this patient, peroral endoscopic myotomy (POEM) was performed for long myotomy of thickened circular muscle. During the procedure, there were no significant complications and she was discharged uneventfully. Symptoms were completely improved during three months after POEM. Here, we report on a case of Jackhammer esophagus treated by POEM.
Subject(s)
Female , Humans , Middle Aged , Endoscopy, Digestive System , Endosonography , Esophageal Motility Disorders/diagnosis , ManometryABSTRACT
A 19-years-old girl was referred for lung transplant due to end stage lung disease secondary to idiopathic bilateral bronchiectasis. Her routine pre lung transplant evaluation showed normal esophageal high-resolution manometry (HRM) and 24-hours impedance pH monitoring. Four weeks after the bilateral sequential lung transplantation (LTx), she developed dysphagia, chest pain and regurgitation, complicated by aspiration pneumonia. Repeated HRM showed Jackhammer esophagus, delayed gastric emptying and abnormal 24-hour pH impedance monitoring consistent with the diagnosis of gastroesophageal reflux disease. Twelve weeks after LTx, she was symptom free, HRM and 24-hour impedance pH monitoring returned to normal. To the best of our knowledge, this rare transient esophageal hypercontractility episode occurred after LTx and recovered without any specific treatment was never reported in literature. The etiopathogenesis of Jackhammer esophagus in general and LTx induced dysmotility in particular is discussed and reviewed.