Clinical features and long‐term outcomes of lower esophageal sphincter‐dependent and lower esophageal sphincter‐independent jackhammer esophagus. Issue 2 (15th November 2018)

• Record Type: Journal Article
• Authors: Kahn, Allon; Al‐Qaisi, Mohanad T.; Obeid, Robert A.; Katzka, David A.; Ravi, Karthik M.; Ramirez, Francisco C.; Crowell, Michael D.; Vela, Marcelo F.
• Is Part Of: Neurogastroenterology & motility. Volume 31:Issue 2(2019)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2018-11-15
• Subjects: dysphagia -- esophageal manometry -- hypercontractile esophagus -- jackhammer esophagus; Gastrointestinal system -- Motility -- Periodicals; Gastrointestinal system -- Innervation -- Periodicals; 616.33
• DOI: 10.1111/nmo.13507
• Languages: English
• ISSNs: 1350-1925

Abstract

Abstract: Background: The most recent Chicago Classification expanded the criteria for diagnosis of jackhammer esophagus (JHE) to include the distal contractile integral (DCI) of the lower esophageal sphincter (LES). The clinical impact of the manometric inclusion of LES hypercontractility remains unclear. We aimed to analyze the clinical features and long‐term outcomes of measured LES‐dependent (LD‐JHE) and LES‐independent (LI‐JHE) jackhammer esophagus. Methods: Patients meeting diagnostic criteria for JHE were identified at two academic medical centers. High‐resolution esophageal manometry data were re‐analyzed with inclusion and exclusion of the LES DCI. LD‐JHE was defined by falling outside JHE diagnostic criteria with exclusion of the LES. A telephone survey was conducted for follow‐up utilizing the impact dysphagia (IDQ‐10) questionnaire. Key Results: Eighty‐one patients met study inclusion criteria, with 12 (14.8%) classified as LD‐JHE. LD‐JHE patients had a significantly lower mean DCI and fewer swallows with DCI >8000 mm Hg‐s‐cm. Basal LES pressure was higher in patients with dysphagia to solids than those with dysphagia to solids and liquids. Clinical and manometric parameters were otherwise similar between groups. Sixty‐six patients had clinical or phone follow‐up at a median of 46.6 months. Forty‐one patients (62.1%) received therapies directed at JHE. There was no difference in symptom improvement for treated vs untreated patients or for JHE subtype. Conclusions and Inferences: Our findings suggest that LD‐JHE and LI‐JHE are clinically indistinguishable and thus support existing diagnostic criteria. Furthermore, our long‐term follow‐up data suggest that JHE, irrespective of LES involvement, may improve without treatment. Further study is needed to clarify which patients merit therapeutic intervention. Abstract : The Chicago Classification diagnostic criteria for jackhammer esophagus (JHE) now include LES hypercontractility. However, the clinical implications of contraction pattern in esophageal hypercontractility are unclear. In a large multicenter retrospective cohort study, we demonstrate no clinically significant differences between JHE that is dependent versus independent of the LES for diagnosis. This supports existing diagnostic criteria. Furthermore, with longitudinal clinical follow‐up, treatment of JHE is not associated with a higher proportion of symptomatic improvement. Further studies are needed to clarify which patients may benefit from therapeutic intervention.