Table of ContentsView AllTable of ContentsCausesSymptomsDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Causes
Symptoms
Diagnosis
Treatment
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Causes of Jackhammer Esophagus
While the cause of jackhammer esophagus is poorly understood, it is associated with several conditions, including the following:
Jackhammer esophagus is also more common in females who are 65 years old or older.
The actual incidence of jackhammer esophagus is unknown. Many cases likely go undiagnosed because the symptoms are mild, and the condition is often misdiagnosed as acid reflux or another condition that causes similar symptoms.
Symptoms of Jackhammer Esophagus
Symptoms of jackhammer esophagus range in severity and overlap with otherdisorders of the esophagus, including GERD, eosinophilic esophagitis, andachalasia. Aside from esophageal spasms, other symptoms may include:
You may notice that symptoms get worse when you eat or are more severe after eating certain foods.
The chest pain that is usually associated with jackhammer esophagus can be severe and cause you to feel as though you are having a heart attack. It may radiate to your back. Seek emergency medical care if you experience heart attack symptoms such as chest pain.
Diagnosing Jackhammer Esophagus
Diagnosing jackhammer esophagus can be difficult. The condition may initially be misdiagnosed as another illness that causes similar symptoms. Your healthcare provider will consider your health history and reported symptoms and conduct a physical exam.
Providers generally utilize one of three tests to diagnose a jackhammer esophagus:esophageal manometry, barium swallow, and upperendoscopy.
Esophageal Manometry
Esophageal manometry, a test that measures esophageal contractions, is considered the best test for diagnosing jackhammer esophagus. Other tests may be used to rule out overlapping conditions. Providers typically utilize a type of manometry called high-resolution manometry.
If at least 20% of swallows have a distal contractile integral (DCI) of greater than 8000 mmHg-s-cm, together withintactperistalsisand distal latency, then a diagnosis of jackhammer esophagus is likely.The DCI measures the strength of the esophageal contraction. Peristalsis is the movement of the smooth muscle in the esophagus. Distal latency is nerve conduction. A normal esophageal contraction is considered between 450–8,000 mmHg-s-cm.
So, if the high-resolution manometry indicates stronger esophageal contractions than typically seen, but the muscle movement and nerve conduction of esophageal contractions seem intact, then it means a likely diagnosis of jackhammer esophagus.
Barium Swallow
Abarium swallowis a special type of X-ray test, also called bariumesophagography. It is often used in addition to upper endoscopy to look for obstructive lesions.
Upper Endoscopy
Anupper endoscopy called anesophagogastroduodenoscopy(EGD) visualizes the upper gastrointestinal (GI) tract. The patient is sedated, and a scope with a small camera and light is inserted to examine the esophagus, stomach, and the first part of the small intestine.
The purpose of an EGD is to rule out other conditions, such as:
Any resistance may be further evaluated with esophageal manometry.
Jackhammer vs. Nutcracker EsophagusYou may hear the term “nutcracker esophagus” in reference to a hypercontractile esophagus. Some use the terms interchangeably.However, the term “nutcracker esophagus” is no longer used. The manometric pattern seen in what was referred to as nutcracker esophagus does not necessarily cause symptoms and can also be seen in asymptomatic individuals.
Jackhammer vs. Nutcracker Esophagus
You may hear the term “nutcracker esophagus” in reference to a hypercontractile esophagus. Some use the terms interchangeably.However, the term “nutcracker esophagus” is no longer used. The manometric pattern seen in what was referred to as nutcracker esophagus does not necessarily cause symptoms and can also be seen in asymptomatic individuals.
You may hear the term “nutcracker esophagus” in reference to a hypercontractile esophagus. Some use the terms interchangeably.
However, the term “nutcracker esophagus” is no longer used. The manometric pattern seen in what was referred to as nutcracker esophagus does not necessarily cause symptoms and can also be seen in asymptomatic individuals.
Treating Jackhammer Esophagus
There are several treatment options for jackhammer esophagus. The cause of jackhammer esophagus is poorly understood, making finding an effective treatment challenging.
Sometimes, a healthcare provider will recommend a wait-and-see approach to treating jackhammer esophagus. Sometimes, the condition will go away on its own, and some treatment options are invasive or have negative side effects.Consult your healthcare provider on the best options for your circumstances.
Dietary and Lifestyle Management
There are several dietary and lifestyle management options available to reduce the symptoms of jackhammer esophagus. Examples include:
You may find a combination of lifestyle modifications along with other interventions most helpful.
Controlling GERD
Gastroesophageal reflux disease (GERD) often presents with jackhammer esophagus. Some evidence suggests that GERD plays a role in developing motility disorders, such as jackhammer esophagus.However, the data are conflicting, and some research indicates that acid exposure is not associated with jackhammer esophagus.
Additionally, some of the medications used to control the hypercontractility associated with jackhammer esophagus can relax thelower esophageal sphincter, which can worsen GERD.
While more research is necessary to understand whether there is a relationship between GERD and jackhammer esophagus, the presence of esophageal acid from GERD may trigger the esophageal spasms seen in jackhammer esophagus. Thus, one treatment option is usingproton pump inhibitorsto reduce the amount of stomach acid produced.
Calcium Channel Blockers and Nitrates
Calcium channel blockersand nitrates relax smooth muscle. A provider may also prescribe phosphodiesterase-5 inhibitors, another medication that can relax smooth muscle. These medications may help to reduce hypercontractility and relax the muscles in the esophagus (which are smooth muscles).
Additional Medications and Supplements
Low-dose antidepressants can effectively reduce chest pain.
While more research is needed on its effectiveness,peppermint oilis a low-cost and relatively safe treatment option that may reduce esophageal contractions.
Botulinum Toxin
Botulinum toxin(botox) is a slightly more invasive treatment option than lifestyle modifications and oral medication. However, it is less invasive and has a lower risk than esophageal dilation and surgery.
Esophageal Dilation
Esophageal dilation involves inflating a special balloon in the lower esophageal sphincter to disrupt it. It is done endoscopically and may need to be repeated to be effective.
Other Esophageal Procedures
Another treatment option isperoral endoscopic myotomy(POEM). Including the lower esophageal sphincter seems to be the most effective in symptom resolution.
In this procedure, your healthcare provider willuse an endoscopeand go through your mouth to access your esophagus. The provider will then cut through the muscles to loosen them.
Summary
Jackhammer esophagus is a condition that causes too-strong esophageal contractions. It can cause several uncomfortable symptoms, including chest pain and swallowing difficulties.
High-resolution manometry measures the strength of esophageal contractions. It is used in conjunction with additional tests to rule out other conditions and aid in diagnosis.
Several treatment options exist, and your healthcare provider can help you establish a treatment plan based on your individual needs.
11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Organization for Rare Diseases.Jackhammer esophagus.Achem SR, Vazquez-Elizondo G, Fass R.Jackhammer esophagus: current concepts and dilemmas.J Clin Gastroenterol. 2021;55(5):369-379.Hong YS, Min YW, Rhee PL.Two Distinct Types of Hypercontractile Esophagus: Classic and Spastic Jackhammer.Gut Liver. 2016;10(5):859–863. doi:10.5009/gnl15388Clément M, Zhu WJ, Neshkova E, Bouin M.Jackhammer Esophagus: From Manometric Diagnosis to Clinical Presentation.Can J Gastroenterol Hepatol.2019;2019:5036160. doi:10.1155/2019/5036160The Chicago classification of esophageal motility disorders, v3. 0.Neurogastroenterol Motil. 2015;27(2):160-174.Wilkinson JM, Halland M.Esophageal motility disorders.American Family Physician. 2020;102(5):291-296.MedlinePlus.EGD - esophagogastroduodenoscopy.Woo M, Liu A, Wilsack L, et al.Gastroesophageal reflux disease is not associated with jackhammer esophagus: a case-control study.J Neurogastroenterol Motil. 2020;26(2):224-231.Sirinawasatien A, Sakulthongthawin P.Manometrically jackhammer esophagus with fluoroscopically/endoscopically distal esophageal spasm: a case report.BMC Gastroenterology. 2021;21(1):222.van Hoeij FB, Tack JF, Pandolfino JE, et al.Complications of botulinum toxin injections for treatment of esophageal motility disorders.Dis Esophagus. 2017;30(3):1-5.Bechara R, Ikeda H, Inoue H.Peroral endoscopic myotomy for Jackhammer esophagus: to cut or not to cut the lower esophageal sphincter.Endosc Int Open. 2016;4(5):E585-E588.
11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Organization for Rare Diseases.Jackhammer esophagus.Achem SR, Vazquez-Elizondo G, Fass R.Jackhammer esophagus: current concepts and dilemmas.J Clin Gastroenterol. 2021;55(5):369-379.Hong YS, Min YW, Rhee PL.Two Distinct Types of Hypercontractile Esophagus: Classic and Spastic Jackhammer.Gut Liver. 2016;10(5):859–863. doi:10.5009/gnl15388Clément M, Zhu WJ, Neshkova E, Bouin M.Jackhammer Esophagus: From Manometric Diagnosis to Clinical Presentation.Can J Gastroenterol Hepatol.2019;2019:5036160. doi:10.1155/2019/5036160The Chicago classification of esophageal motility disorders, v3. 0.Neurogastroenterol Motil. 2015;27(2):160-174.Wilkinson JM, Halland M.Esophageal motility disorders.American Family Physician. 2020;102(5):291-296.MedlinePlus.EGD - esophagogastroduodenoscopy.Woo M, Liu A, Wilsack L, et al.Gastroesophageal reflux disease is not associated with jackhammer esophagus: a case-control study.J Neurogastroenterol Motil. 2020;26(2):224-231.Sirinawasatien A, Sakulthongthawin P.Manometrically jackhammer esophagus with fluoroscopically/endoscopically distal esophageal spasm: a case report.BMC Gastroenterology. 2021;21(1):222.van Hoeij FB, Tack JF, Pandolfino JE, et al.Complications of botulinum toxin injections for treatment of esophageal motility disorders.Dis Esophagus. 2017;30(3):1-5.Bechara R, Ikeda H, Inoue H.Peroral endoscopic myotomy for Jackhammer esophagus: to cut or not to cut the lower esophageal sphincter.Endosc Int Open. 2016;4(5):E585-E588.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
National Organization for Rare Diseases.Jackhammer esophagus.Achem SR, Vazquez-Elizondo G, Fass R.Jackhammer esophagus: current concepts and dilemmas.J Clin Gastroenterol. 2021;55(5):369-379.Hong YS, Min YW, Rhee PL.Two Distinct Types of Hypercontractile Esophagus: Classic and Spastic Jackhammer.Gut Liver. 2016;10(5):859–863. doi:10.5009/gnl15388Clément M, Zhu WJ, Neshkova E, Bouin M.Jackhammer Esophagus: From Manometric Diagnosis to Clinical Presentation.Can J Gastroenterol Hepatol.2019;2019:5036160. doi:10.1155/2019/5036160The Chicago classification of esophageal motility disorders, v3. 0.Neurogastroenterol Motil. 2015;27(2):160-174.Wilkinson JM, Halland M.Esophageal motility disorders.American Family Physician. 2020;102(5):291-296.MedlinePlus.EGD - esophagogastroduodenoscopy.Woo M, Liu A, Wilsack L, et al.Gastroesophageal reflux disease is not associated with jackhammer esophagus: a case-control study.J Neurogastroenterol Motil. 2020;26(2):224-231.Sirinawasatien A, Sakulthongthawin P.Manometrically jackhammer esophagus with fluoroscopically/endoscopically distal esophageal spasm: a case report.BMC Gastroenterology. 2021;21(1):222.van Hoeij FB, Tack JF, Pandolfino JE, et al.Complications of botulinum toxin injections for treatment of esophageal motility disorders.Dis Esophagus. 2017;30(3):1-5.Bechara R, Ikeda H, Inoue H.Peroral endoscopic myotomy for Jackhammer esophagus: to cut or not to cut the lower esophageal sphincter.Endosc Int Open. 2016;4(5):E585-E588.
National Organization for Rare Diseases.Jackhammer esophagus.
Achem SR, Vazquez-Elizondo G, Fass R.Jackhammer esophagus: current concepts and dilemmas.J Clin Gastroenterol. 2021;55(5):369-379.
Hong YS, Min YW, Rhee PL.Two Distinct Types of Hypercontractile Esophagus: Classic and Spastic Jackhammer.Gut Liver. 2016;10(5):859–863. doi:10.5009/gnl15388
Clément M, Zhu WJ, Neshkova E, Bouin M.Jackhammer Esophagus: From Manometric Diagnosis to Clinical Presentation.Can J Gastroenterol Hepatol.2019;2019:5036160. doi:10.1155/2019/5036160
The Chicago classification of esophageal motility disorders, v3. 0.Neurogastroenterol Motil. 2015;27(2):160-174.
Wilkinson JM, Halland M.Esophageal motility disorders.American Family Physician. 2020;102(5):291-296.
MedlinePlus.EGD - esophagogastroduodenoscopy.
Woo M, Liu A, Wilsack L, et al.Gastroesophageal reflux disease is not associated with jackhammer esophagus: a case-control study.J Neurogastroenterol Motil. 2020;26(2):224-231.
Sirinawasatien A, Sakulthongthawin P.Manometrically jackhammer esophagus with fluoroscopically/endoscopically distal esophageal spasm: a case report.BMC Gastroenterology. 2021;21(1):222.
van Hoeij FB, Tack JF, Pandolfino JE, et al.Complications of botulinum toxin injections for treatment of esophageal motility disorders.Dis Esophagus. 2017;30(3):1-5.
Bechara R, Ikeda H, Inoue H.Peroral endoscopic myotomy for Jackhammer esophagus: to cut or not to cut the lower esophageal sphincter.Endosc Int Open. 2016;4(5):E585-E588.
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