Hypercontractile Peristalsis or Jackhammer Esophagus

Jackhammer esophagus, or hypercontractile peristalsis, is an esophageal motility disorder that is characterized by esophageal spasms that involve all or most of the muscles of the esophagus. The spasms are so intense and tend to last for a long time, making the name of the disorder, jackhammer esophagus, an adequate description of how a person with the disorder might feel.

Causes

The underlying causes of jackhammer esophagus are not well understood but the condition may be caused by abnormalities in the nerve pathways that control the esophagus or an increase in the amount of acetylcholine. Some health professionals believe that jackhammer esophagus is triggered by gastroesophageal reflux disease (GERD).

The condition seems to be more common among individuals who also have psychiatric illnesses and the condition is sometimes successfully treated with tricyclic antidepressants. This does not mean that psychiatric illness causes jackhammer esophagus or that a person with jackhammer esophagus also has a psychiatric illness, only that there seems to be some association between the two conditions.

Jackhammer esophagus is also more common in:

• Caucasians than those of other ethnic backgrounds
• More likely to affect women than men
• More likely to affect adults than children.

The actual incidence of jackhammer esophagus is unknown, many cases likely go undiagnosed because symptoms are mild and the condition is often misdiagnosed as acid reflux or another condition which cause similar symptoms.

Symptoms

Symptoms of jackhammer esophagus range in severity and overlap with many other disorders of the esophagus including GERD, eosinophilic esophagitis, and achalasia. Aside from esophageal spasms, other symptoms may include:

• Chest pain
• Feeling like there is a lump in your throat
• Difficulty swallowing
• Regurgitation
• Heartburn

You may notice that symptoms get worse when you eat or are more severe after eating certain foods.

Diagnosis

Diagnosing jackhammer esophagus can be difficult and as previously mentioned the condition is often misdiagnosed as another illness which causes similar symptoms. Your healthcare provider will consider your health history, reported symptoms, and likely conduct a physical exam.

Two tests, in particular, are usually needed to diagnose jackhammer esophagus, a barium swallow or esophageal manometry. Esophageal manometry, a test that measures esophageal contractions, is considered the best test for diagnosing jackhammer esophagus. Other tests may be used to rule out overlapping conditions but the results of those tests will not ultimately indicate jackhammer esophagus.

Treatments

Dietary Management: Controlling acid reflux may be helpful in reducing the pain associated with jackhammer esophagus. While no specific diet is currently recommended it may be helpful to:

• Avoid eating late at night
• Stay away from foods that commonly cause heartburn, (such as carbonated beverages)
• Keep a food journal to identify foods that may worsen your symptoms

Medications: The symptoms of jackhammer esophagus can sometimes be managed using medications. Medications that may be useful include:

• Tricyclic antidepressants (like imipramine) are one of the most successful medications used.
• Proton pump inhibitors (like Dexilantor Nexium) which reduce the amount of acid in the stomach and esophagus
• Calcium channel blockers (like Verapamil)
• Smooth muscle relaxers (like Viagra)
• Nitrates (like nitroglycerin or isosorbide mononitrate) are sometimes helpful in reducing chest pain
• Botulinum toxin injected by endoscopy into the lower esophageal sphincter has been successful in temporarily reducing symptoms

Other Procedures: Esophageal dilation is sometimes helpful if difficulty swallowing or a constant feeling that there is something stuck in the throat is a problem. This is done with an endoscope under sedation, usually as a same-day procedure.

For those cases where other treatments have been unsuccessful in controlling symptoms a surgical procedure a less invasive surgical technique call Per Oral Endoscopic Myotomy (POEM) may be used, otherwise, a standard myotomy (a surgical procedure to cut esophageal muscle) may be used. As a last resort esophagectomy may be performed but is reserved for those with severe symptoms who have exhausted other possible treatments.