Jackhammer esophagus is a motility disorder affecting the esophagus, the tube that carries food from the mouth to the stomach. It is defined by unusually strong, coordinated muscle contractions, or spasms, during swallowing that are significantly more forceful than normal. This condition is considered rare, and its exact prevalence is unknown.
Symptoms and Common Triggers
The most common symptoms of jackhammer esophagus are chest pain and difficulty swallowing, known as dysphagia. The chest pain can be severe, sometimes radiating to the back, and may be mistaken for a heart attack. Dysphagia can occur with both solids and liquids, often with a sensation that food is stuck in the throat or chest.
Some individuals may also experience regurgitation, heartburn, and excessive burping. Symptoms can be provoked by eating too quickly or consuming very hot or cold foods and beverages. Stress and anxiety are also thought to be potential triggers.
Associated Conditions and Potential Causes
The precise cause of jackhammer esophagus is not fully understood and is often idiopathic, meaning it arises without a known cause. Researchers have identified abnormalities in the nerve pathways that control the esophageal muscles as a potential factor, as disruptions in these signals may lead to the disorder’s forceful contractions.
Gastroesophageal reflux disease (GERD) is frequently associated with jackhammer esophagus. Chronic acid reflux can damage the esophageal lining, possibly contributing to muscle spasms. Other less common associations include opioid use and certain autoimmune disorders.
How Jackhammer Esophagus Is Diagnosed
Diagnosing jackhammer esophagus involves ruling out other conditions with similar symptoms. An upper endoscopy may be performed, where a flexible tube with a camera is used to inspect the inside of the esophagus for inflammation, blockages, or other abnormalities.
The definitive diagnostic test is high-resolution esophageal manometry. During this test, a thin tube is passed through the nose into the esophagus, containing sensors that measure the pressure of muscle contractions as you swallow water. A diagnosis is confirmed if at least 20% of swallows show a distal contractile integral (DCI) greater than 8,000 mmHg-s-cm, a measure of contraction force.
Treatment and Management Options
Treatment for jackhammer esophagus is focused on managing symptoms. Lifestyle and dietary changes are often the first line of defense, including eating smaller, more frequent meals and avoiding known trigger foods like those that are very hot, cold, or spicy.
Medications are commonly used to relax the esophageal muscles. Calcium channel blockers and nitrates can reduce the intensity of the spasms. For individuals whose condition is linked to GERD, proton pump inhibitors (PPIs) may be prescribed to reduce stomach acid.
For more persistent symptoms, botulinum toxin (Botox) injections can be administered into the esophageal muscle during an endoscopy. The toxin temporarily paralyzes the muscle, providing relief from spasms, but the effects are not permanent and repeated injections may be necessary.
In severe cases that do not respond to other treatments, a surgical procedure may be considered. Peroral endoscopic myotomy (POEM) is a minimally invasive technique where a surgeon cuts the muscles of the lower esophagus to weaken the contractions.