Introduction Jackhammer oesophagus is a relatively new diagnosis based on high resolution manometry(HRM). It is rare and the management of this condition remains unclear. We aim to study the symptomology, diagnosis and management of patients with Jackhammer oesophagus in a tertiary teaching hospital, which is responsible for HRM assessment for a population of 1.2 million in the Scotland.
Method Retrospective study from 01/10/2012 to 31/12/2016. Patients with at least one hypercontractile swallow (distal contractile integral[DCI]>8000 mmHg/s/cm) on HRM were analysed. Demographics, symptoms, HRM findings, and subsequent management plan were obtained from the local database and electronic record.
Results 16 (9F:7M) patients were identified. Median age at diagnosis was 61.2y(Max: 84.6y Min:43.9y). Three most common presenting complaints were dysphagia 15 (93.8%), regurgitation 9 (56.3%), and globus sensation 7 (43.8%). The median duration of symptoms reported by the patient prior to diagnosis was 4 years (Max: 20y Min: 0.1y). 12 (75%) patients were referred from general practice, 2 (12.5%) from respiratory medicine, 1 (6.3%) from ENT surgery and 1 (6.3%) from internal medicine. The median duration from referral to diagnosis was 126d (Max: 1320d Min: 85d). 11 (68.8%) had barium swallow. Of these, 8 (72.7%) were abnormal; findings included tertiary contraction, contrast stasis and oesophageal diverticulum. 15 (93.8%) had gastroscopy. Endoscopic findings can be classified into: 6 (40%) with hiatus hernia or reflux oesophagitis, 4 (26.7%) with gastritis or duodenitis, 3 (20%) with lower oesophageal hypertonicity and 2 (13.3%) were normal. Only 2 (12.5%) had 24 h pH study, which were normal. 1 (6.3%) had nuclear medicine study confirming delayed gastric emptying. Heterogenous treatment strategies were employed included: GTN 6 (43.8%), Sildenafil 2 (12.5%), BOTOX injection 1 (6.3%), and Nifedipine 2 (12.5%). Of these, only those who had Nifedipine had temporary symptom response. Median follow-up was 361.5d(Max: 1620d Min: 96d). At last follow-up, only 2 (12.5%) had symptom resolution with proton pump inhibition while 14 (87.5%) remained symptomatic.
Conclusion Jackhammer oesophagus is a heterogenous motility disorder of the oesophagus. Most patients have prolonged symptoms prior to diagnosis. To date, no effective treatment has been identified and most patients remain symptomatic. Novel approach such as peroral endoscopic myotomy (POEM) may be a valuable option in selected subset of patients with Jackhammer oesophagus.
. Herregods TVK, et al. Jackhammer oesophagus: observations on a European cohort. Neurogastroenterology & Motility. 2016;1–8.
Disclosure of Interest None Declared
- FUNCTIONAL DISORDER
- jackhammer oesophagus