Published online Dec 16, 2017. doi: 10.4253/wjge.v9.i12.590
Peer-review started: August 27, 2017
First decision: October 9, 2017
Revised: October 25, 2017
Accepted: November 11, 2017
Article in press: November 11, 2017
Published online: December 16, 2017
Processing time: 102 Days and 4.5 Hours
A 60-year-old man with a 1-year history of intermittent and recurrent episodes of dysphagia, chest pain and heartburn, who had taken PPIs for a long time, but without relief of any symptoms.
Dysphagia, chest pain and heartburn and depressive state.
Achalasia, gastroesophageal reflux disease, esophageal infections, esophageal carcinoma, coronary heart disease.
All laboratory parameters were within normal limits.
High-resolution manometry (HRM) showed six swallows with distal contractile integral (DCI) > 8000 mmHg-s-cm in 10 liquid swallows and integrated relaxation pressure (IRP) 14.7 mmHg.
Esophageal mucosa appeared as ectopia of gastric mucosa.
Deanxit for 6 mo, gradually reduced until withdrawal.
Jackhammer esophagus is a rare disorder, and current treatments are limited, such as botulinum toxin injection, peroral endoscopic myotomy, and balloon dilatation.
Jackhammer esophagus is a rare esophagus disorder, and patients with extreme phenotypes of esophageal hypercontractility present mainly with dysphagia, chest pain, and gastroesophageal reflux symptoms. Jackhammer esophagus is described by a new Chicago Classification version 3.0 with at least two swallows with DCI > 8000 mmHg-s-cm.
Patients with esophageal hypercontractility present mainly with dysphagia, chest pain, and HRM is the primary diagnostic method. Patients may also have mental illness, so at the time of diagnosis, psychological evaluation is necessary. Antianxiety and antidepressant agents are promising medical treatment to relieve symptoms in patients with jackhammer esophagus combined with psychosocial problems, but longer follow-up is needed.