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Jackhammer esophagus: A meta‐analysis of patient demographics, disease presentation, high‐resolution manometry data, and treatment outcomes
Author(s) -
Wahba George,
Bouin Mickael
Publication year - 2020
Publication title -
neurogastroenterology and motility
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.489
H-Index - 105
eISSN - 1365-2982
pISSN - 1350-1925
DOI - 10.1111/nmo.13870
Subject(s) - medicine , high resolution manometry , dysphagia , meta analysis , myotomy , esophagus , esophageal motility disorder , confidence interval , reflux , gastroenterology , achalasia , surgery , disease
Background Jackhammer esophagus (JE) is a newly described esophageal motility disorder. However, there are limited data on JE and this entity remains misunderstood. Methods We performed a systematic review of clinical series on JE through MEDLINE, EMBASE, and Web of Science. Data from included studies were then extracted, and random‐effects meta‐analyses were performed. Results Thirty‐eight studies met inclusion criteria. The pooled prevalence of JE was 1.97% [95% CI: 1.39%‐2.78%] among patients referred for high‐resolution manometry (HRM). The mean age at diagnosis was 60.8 years [95% CI: 57.1‐64.4] and 65% [95% CI: 58%‐72%] of patients were female. JE was significantly more prevalent in postlung transplant patients and morbidly obese patients undergoing HRM (23.99% [95% CI: 9.00%‐38.97%] and 5.18% [95% CI: 1.76%‐14.3%] respectively). Dysphagia was the most common presentation of JE (64% [95% CI: 52%‐77%]) followed by gastroesophageal reflux disease (46% [95% CI: 26%‐67%]). The pooled mean distal contractile integral (DCI) of all standard HRM swallows was 9249 mm Hg·s·cm [95% CI: 7834‐10 663], and the pooled mean integrated relaxation pressure (IRP) was 13.9 mm Hg [95% CI: 8.2‐19.7]. Overall, 73.6% [95% CI: 64.0%‐83.1%] of JE patients who underwent treatment achieved clinical symptom improvement (79% [95% CI: 74%‐85%] for endoscopic treatment and 63% [95% CI: 47%‐79%] for medical treatment). The pooled clinical success rate of peroral endoscopic myotomy (POEM) specifically was 82% [95% CI: 75%‐90%]. Conclusions JE is a new motility disorder most commonly presenting with dysphagia. High clinical suspicion is important because the diagnosis can only be made through HRM.