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Am J Physiol Gastrointest Liver Physiol. 2018 Dec 13. doi: 10.1152/ajpgi.00342.2018. [Epub ahead of print]

PROVOCATIVE TESTING IN PATIENTS WITH JACKHAMMER ESOPHAGUS: EVIDENCE FOR ALTERED NEURAL CONTROL.

Author information

1
Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Università degli Studi di Milano - Italy, Italy.
2
Division of Gastroenterology, Washington University in St. Louis.
3
Division of General and Bariatric Surgery, Department of Surgery, Second University of Naples, Italy.
4
University of Padua, Italy.
5
Division of Gastroenterology, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Cisanello Hospital, Italy.
6
Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Italy.
7
Division of Gastroenterology, Washington University School of Medicine, St Louis, MO, United States.
8
Cattedra di Gastroenterologia, IRCCS Ospedale Maggiore, Italy.

Abstract

BACKGROUND:

Jackhammer esophagus (JE) is a hypercontractile disorder, the pathogenesis of which is incompletely understood. Multiple rapid swallows (MRS) and rapid drink challenge (RDC) are complementary tests used during high resolution manometry (HRM) that evaluate inhibitory and excitatory neuromuscular function and latent obstruction respectively. Methods&aim. Our aim was to evaluate esophageal pathophysiology using MRS and RDC in 83 JE patients (28 males; 63; 54-70 years). Twenty one healthy subjects (11 males; 28; 26-30 years) were used as a control group. All patients underwent solid state HRM with ten 5 ml single swallows (SS) and one to three 10 ml MRS; 34 patients also underwent RDC. Data are shown as median-IQ range.

RESULTS:

Abnormal motor inhibition was noted during at least one MRS in 48% of JE vs 29% of controls (p=0.29). Mean DCI after MRS was significantly lower than after SS 6028 (3678-9267) mmHg.cm.s vs 7514 (6238-9197) mmHg.cm.s, p=0.02, as was highest DCI (p<0.0001). Consequently, 66% of JE patients had no contraction reserve. At least one variable of obstruction during RDC (performed in 34 patients) was outside the normal range in 25(74%) of JE. Both highest DCI after SS and pressure gradient across the esophagogastric junction during RDC were higher in patients with dysphagia vs those without (p=0.04 and 0.01 respectively).

CONCLUSIONS:

Our data suggest altered neural control in JE patients with heterogeneity in inhibitory function. Furthermore, some patients had latent esophagogastric junction obstruction during RDC which correlated with the presence of dysphagia.

KEYWORDS:

High resolution manometry; dysphagia; jackhammer esophagus; multiple rapid swallows; rapid drink challenge

PMID:
30543463
DOI:
10.1152/ajpgi.00342.2018

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