Do Jackhammer contractions lead to achalasia? A longitudinal study

Area of Science:

• Gastroenterology
• Esophageal Motility Disorders
• High-Resolution Manometry

Background:

• Jackhammer esophagus (JE) is a rare esophageal motility disorder characterized by high distal contractile integral (DCI) on high-resolution manometry (HRM).
• The natural manometric course and progression of JE remain largely unknown.
• This study investigates the potential development of achalasia in patients diagnosed with JE.

Purpose of the Study:

• To examine the natural manometric progression of Jackhammer esophagus (JE).
• To identify if JE can evolve into achalasia.
• To determine manometric risk factors predicting this progression.

Main Methods:

• Retrospective longitudinal study of patients with multiple HRM recordings (2005-2015).
• Assessment for development of achalasia from initial JE diagnosis.
• Univariate analysis of demographic and manometric factors for progression.

Main Results:

• Twelve subjects met criteria for JE, with 347 patient-months of manometric follow-up.
• Three of 12 subjects with JE progressed to type III achalasia over a mean of 24 months.
• Impaired esophago-gastric junction relaxation at JE diagnosis predicted progression to achalasia (P<.01).

Conclusions:

• Jackhammer esophagus (JE) can naturally progress to achalasia.
• Manometric findings at the time of JE diagnosis, particularly impaired esophago-gastric junction relaxation, are predictive of achalasia development.
• This highlights the importance of close monitoring for JE patients.