Jackhammer esophagus with and without esophagogastric junction outflow obstruction demonstrates altered neural control resembling type 3 achalasia

Farhan Quader, Aurelio Mauro, Edoardo Savarino, Salvatore Tolone, Nicola de Bortoli, Marianna Franchina, Matteo Ghisa, Krista Edelman, Lokesh K. Jha, Roberto Penagini, C. Prakash Gyawali

Research output: Contribution to journalArticle

Abstract

Background: Esophageal hypercontractility can manifest with and without esophagogastric junction (EGJ) outflow obstruction. We investigated clinical presentations and motility patterns in patients with esophageal hypercontractile disorders. Methods: Esophageal HRM studies fulfilling Chicago Classification 3.0 criteria for jackhammer esophagus (distal contractile integral, DCI >8000 mmHg.cm.s in ≥ 20% swallows) with (n = 30) and without (n = 83) EGJ obstruction (integrated relaxation pressure, IRP > 15 mm Hg) were retrospectively reviewed from five centers (4 in Europe, 1 in US). Single swallows (SS) and multiple rapid swallows (MRS) were analyzed using HRM software tools (IRP, DCI, distal latency, DL); MRS: SS DCI ratio >1 defined contraction reserve. Comparison groups were achalasia type 3 (n = 72, positive control for abnormal inhibition and EGJ obstruction) and healthy controls (n = 18). Symptoms, HRM metrics, and MRS contraction reserve were analyzed within jackhammer subgroups and comparison groups. Key Results: The esophageal smooth muscle was excessively stimulated at baseline in jackhammer subgroups, with lack of augmentation following MRS identified more often compared with controls (P =.003) and type 3 achalasia (P =.07). Consistently abnormal inhibition was identified in type 3 achalasia (47%), and to a lower extent in jackhammer with obstruction (37%, P =.33), jackhammer esophagus (28%, P =.01), and controls (11%, P <.01 compared with type 3 achalasia). Perceptive symptoms (heartburn, chest pain) were common in jackhammer esophagus (P <.01 compared with type 3 achalasia), while transit symptoms (dysphagia) were more frequent with presence of EGJ obstruction (P ≤.01 compared with jackhammer without obstruction). Conclusions and inferences: The balance of excessive excitation and abnormal inhibition defines clinical and manometric manifestations in esophageal hypercontractile disorders.

Original languageEnglish
Article numbere13678
JournalNeurogastroenterology and Motility
Volume31
Issue number9
DOIs
Publication statusPublished - Jan 1 2019

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Swallows
Esophagogastric Junction
Esophageal Achalasia
Esophagus
Heartburn
Deglutition Disorders
Chest Pain
Smooth Muscle
Software
Pressure

Keywords

  • dysphagia
  • high-resolution manometry
  • hypercontractile disorders
  • jackhammer esophagus
  • multiple rapid swallows
  • type 3 achalasia

ASJC Scopus subject areas

  • Physiology
  • Endocrine and Autonomic Systems
  • Gastroenterology

Cite this

Jackhammer esophagus with and without esophagogastric junction outflow obstruction demonstrates altered neural control resembling type 3 achalasia. / Quader, Farhan; Mauro, Aurelio; Savarino, Edoardo; Tolone, Salvatore; de Bortoli, Nicola; Franchina, Marianna; Ghisa, Matteo; Edelman, Krista; Jha, Lokesh K.; Penagini, Roberto; Gyawali, C. Prakash.

In: Neurogastroenterology and Motility, Vol. 31, No. 9, e13678, 01.01.2019.

Research output: Contribution to journalArticle

Quader, F, Mauro, A, Savarino, E, Tolone, S, de Bortoli, N, Franchina, M, Ghisa, M, Edelman, K, Jha, LK, Penagini, R & Gyawali, CP 2019, 'Jackhammer esophagus with and without esophagogastric junction outflow obstruction demonstrates altered neural control resembling type 3 achalasia', Neurogastroenterology and Motility, vol. 31, no. 9, e13678. https://doi.org/10.1111/nmo.13678
Quader, Farhan ; Mauro, Aurelio ; Savarino, Edoardo ; Tolone, Salvatore ; de Bortoli, Nicola ; Franchina, Marianna ; Ghisa, Matteo ; Edelman, Krista ; Jha, Lokesh K. ; Penagini, Roberto ; Gyawali, C. Prakash. / Jackhammer esophagus with and without esophagogastric junction outflow obstruction demonstrates altered neural control resembling type 3 achalasia. In: Neurogastroenterology and Motility. 2019 ; Vol. 31, No. 9.
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abstract = "Background: Esophageal hypercontractility can manifest with and without esophagogastric junction (EGJ) outflow obstruction. We investigated clinical presentations and motility patterns in patients with esophageal hypercontractile disorders. Methods: Esophageal HRM studies fulfilling Chicago Classification 3.0 criteria for jackhammer esophagus (distal contractile integral, DCI >8000 mmHg.cm.s in ≥ 20{\%} swallows) with (n = 30) and without (n = 83) EGJ obstruction (integrated relaxation pressure, IRP > 15 mm Hg) were retrospectively reviewed from five centers (4 in Europe, 1 in US). Single swallows (SS) and multiple rapid swallows (MRS) were analyzed using HRM software tools (IRP, DCI, distal latency, DL); MRS: SS DCI ratio >1 defined contraction reserve. Comparison groups were achalasia type 3 (n = 72, positive control for abnormal inhibition and EGJ obstruction) and healthy controls (n = 18). Symptoms, HRM metrics, and MRS contraction reserve were analyzed within jackhammer subgroups and comparison groups. Key Results: The esophageal smooth muscle was excessively stimulated at baseline in jackhammer subgroups, with lack of augmentation following MRS identified more often compared with controls (P =.003) and type 3 achalasia (P =.07). Consistently abnormal inhibition was identified in type 3 achalasia (47{\%}), and to a lower extent in jackhammer with obstruction (37{\%}, P =.33), jackhammer esophagus (28{\%}, P =.01), and controls (11{\%}, P <.01 compared with type 3 achalasia). Perceptive symptoms (heartburn, chest pain) were common in jackhammer esophagus (P <.01 compared with type 3 achalasia), while transit symptoms (dysphagia) were more frequent with presence of EGJ obstruction (P ≤.01 compared with jackhammer without obstruction). Conclusions and inferences: The balance of excessive excitation and abnormal inhibition defines clinical and manometric manifestations in esophageal hypercontractile disorders.",
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AU - Mauro, Aurelio

AU - Savarino, Edoardo

AU - Tolone, Salvatore

AU - de Bortoli, Nicola

AU - Franchina, Marianna

AU - Ghisa, Matteo

AU - Edelman, Krista

AU - Jha, Lokesh K.

AU - Penagini, Roberto

AU - Gyawali, C. Prakash

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N2 - Background: Esophageal hypercontractility can manifest with and without esophagogastric junction (EGJ) outflow obstruction. We investigated clinical presentations and motility patterns in patients with esophageal hypercontractile disorders. Methods: Esophageal HRM studies fulfilling Chicago Classification 3.0 criteria for jackhammer esophagus (distal contractile integral, DCI >8000 mmHg.cm.s in ≥ 20% swallows) with (n = 30) and without (n = 83) EGJ obstruction (integrated relaxation pressure, IRP > 15 mm Hg) were retrospectively reviewed from five centers (4 in Europe, 1 in US). Single swallows (SS) and multiple rapid swallows (MRS) were analyzed using HRM software tools (IRP, DCI, distal latency, DL); MRS: SS DCI ratio >1 defined contraction reserve. Comparison groups were achalasia type 3 (n = 72, positive control for abnormal inhibition and EGJ obstruction) and healthy controls (n = 18). Symptoms, HRM metrics, and MRS contraction reserve were analyzed within jackhammer subgroups and comparison groups. Key Results: The esophageal smooth muscle was excessively stimulated at baseline in jackhammer subgroups, with lack of augmentation following MRS identified more often compared with controls (P =.003) and type 3 achalasia (P =.07). Consistently abnormal inhibition was identified in type 3 achalasia (47%), and to a lower extent in jackhammer with obstruction (37%, P =.33), jackhammer esophagus (28%, P =.01), and controls (11%, P <.01 compared with type 3 achalasia). Perceptive symptoms (heartburn, chest pain) were common in jackhammer esophagus (P <.01 compared with type 3 achalasia), while transit symptoms (dysphagia) were more frequent with presence of EGJ obstruction (P ≤.01 compared with jackhammer without obstruction). Conclusions and inferences: The balance of excessive excitation and abnormal inhibition defines clinical and manometric manifestations in esophageal hypercontractile disorders.

AB - Background: Esophageal hypercontractility can manifest with and without esophagogastric junction (EGJ) outflow obstruction. We investigated clinical presentations and motility patterns in patients with esophageal hypercontractile disorders. Methods: Esophageal HRM studies fulfilling Chicago Classification 3.0 criteria for jackhammer esophagus (distal contractile integral, DCI >8000 mmHg.cm.s in ≥ 20% swallows) with (n = 30) and without (n = 83) EGJ obstruction (integrated relaxation pressure, IRP > 15 mm Hg) were retrospectively reviewed from five centers (4 in Europe, 1 in US). Single swallows (SS) and multiple rapid swallows (MRS) were analyzed using HRM software tools (IRP, DCI, distal latency, DL); MRS: SS DCI ratio >1 defined contraction reserve. Comparison groups were achalasia type 3 (n = 72, positive control for abnormal inhibition and EGJ obstruction) and healthy controls (n = 18). Symptoms, HRM metrics, and MRS contraction reserve were analyzed within jackhammer subgroups and comparison groups. Key Results: The esophageal smooth muscle was excessively stimulated at baseline in jackhammer subgroups, with lack of augmentation following MRS identified more often compared with controls (P =.003) and type 3 achalasia (P =.07). Consistently abnormal inhibition was identified in type 3 achalasia (47%), and to a lower extent in jackhammer with obstruction (37%, P =.33), jackhammer esophagus (28%, P =.01), and controls (11%, P <.01 compared with type 3 achalasia). Perceptive symptoms (heartburn, chest pain) were common in jackhammer esophagus (P <.01 compared with type 3 achalasia), while transit symptoms (dysphagia) were more frequent with presence of EGJ obstruction (P ≤.01 compared with jackhammer without obstruction). Conclusions and inferences: The balance of excessive excitation and abnormal inhibition defines clinical and manometric manifestations in esophageal hypercontractile disorders.

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