Jackhammer Esophagus

What is jackhammer esophagus?

Jackhammer esophagus is a specific disorder of the motility of the esophagus. Normally, the esophageal muscle contracts in a coordinated fashion to help propel food from the mouth and into the stomach. Jackhammer esophagus is a specific disorder of the muscular action of the esophagus (aka “dysmotility”) wherein there are high amplitude abnormal contractions (“spasm”) of the esophageal muscle. These contractions are of much higher force than normal and also are discoordinated compared to normal contraction.

What causes jackhammer esophagus?

The cause of the disorder is unknown and it can arise in anyone, though it is considered rare.

What are the symptoms of jackhammer esophagus?

Patients with jackhammer esophagus typically have difficulty swallowing food and/or liquids, a sensation or food or liquid getting stuck in the throat or chest, chest pain, regurgitation, and/or weight loss. Heartburn is possible, though not a characteristic symptom.

How is jackhammer esophagus diagnosed?

Jackhammer esophagus is one of several dysmotility disorders of the esophagus that are specifically recognized and diagnosed with specialized testing. When patients have swallowing difficulty, testing may include upper endoscopy (EGD), esophageal manometry, and/or esophagram (aka barium swallow). These tests can identify jackhammer esophagus or other dysmotility disorders of the esophagus.

How is jackhammer esophagus treated?

There is no known cure for this disorder.  All of the treatment options are palliative, meaning they strive to reduce or eliminate the major symptoms by eliminating or minimizing spasm.  These treatment options aim to relax or disrupt the muscle of the esophagus and allow food to enter the stomach more easily.

Medications (such as calcium channel blockers or nitrates) have been used to treat the symptoms of esophageal spasm; they often have intolerable side effects and may not be definitive or durably effective and are thus used somewhat infrequently as the main therapy.

Botulinum toxin (BoTox) injected into the muscle of the esophagus with endoscopic guidance works by paralyzing the muscle and allowing relaxation. Although it is easy to perform and can be initially effective in relieving symptoms, the effects are often temporary (typically on the order of weeks to months) and repeated injections lose efficacy. Furthermore, repeated injections can cause inflammation and scarring that can make more definitive treatments difficult or risky. As such, botulinum toxin should only be used for selected cases. Sometimes botulinum toxin is used as a therapeutic trial to see if paralysis of the muscle will relieve symptoms and indicate that a patient may be eligible for other treatment.

It is thought that for many patients the most effective and durable treatment for jackhammer esophagus is cutting the muscle; this is called myotomy. This can be accomplished endoscopically (referred to as Per-oral endoscopic myotomy or POEM). POEM is primarily used to treat achalasia but it has been successfully applied to patients with jackhammer esophagus since there are not other reliable, durable, and safe interventions available.