Hypercontractile esophagus responsive to potassium-competitive acid blockers: a case report

Area of Science:

• Gastroenterology
• Esophageal Motility Disorders
• Pharmacology

Background:

• Hypercontractile esophagus is a rare esophageal motility disorder with unknown etiology.
• An association between acid reflux and hypercontractile esophagus has been suggested.
• This study reports the first use of potassium-competitive acid blockers (P-CABs) for hypercontractile esophagus.

Observation:

• A 43-year-old male presented with a year of dysphagia, chest pain, and regurgitation.
• Initial investigations revealed esophageal abnormalities and abnormal acid exposure, unresponsive to proton pump inhibitors (PPIs).
• High-resolution esophageal manometry confirmed hypercontractile esophagus.

Findings:

• Treatment with vonoprazan, a P-CAB, led to complete symptomatic resolution.
• Follow-up high-resolution manometry showed normalization of esophageal contractions.
• Vonoprazan offers an alternative therapeutic option for PPI-refractory hypercontractile esophagus.

Implications:

• P-CABs may be a viable treatment for hypercontractile esophagus, especially in PPI-refractory cases.
• This finding supports the hypothesis of an acid-related etiology in some cases of hypercontractile esophagus.
• Further research into P-CABs for hypercontractile esophagus is warranted to establish efficacy and explore underlying mechanisms.