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. 2018 May;30(5):e13262.
doi: 10.1111/nmo.13262. Epub 2017 Nov 29.

Jackhammer esophagus: Assessing the balance between prepeak and postpeak contractile integral

Y Xiao  1 , D A Carlson  2 , Z Lin  2 , N Alhalel  2 , J E Pandolfino  2
Affiliations

Jackhammer esophagus: Assessing the balance between prepeak and postpeak contractile integral

Y Xiao et al. Neurogastroenterol Motil. 2018 May.

Abstract

Background: We hypothesized that symptoms in Jackhammer esophagus (JH) are associated with an imbalance between the prepeak and postpeak phases of contraction. Thus, we developed a method to distinguish the contractile integral components of prepeak and postpeak phase contractile activity to determine the contribution of each phase and their association with dysphagia.

Methods: Patients diagnosed with JH were enrolled and compared to controls. The first five intact swallows during manometry were analyzed. A single swallow was divided into a prepeak and postpeak phase. The contractile integral of each phase and its corresponding time-controlled integral were computed. All metrics were compared between controls and JH patients subcategorized by the impaction dysphagia question (IDQ) score with cut-off of 6.

Key results: Thirty eight JH patients and 71 controls were included. Twelve JH patients had IDQ ≤ 6 and 26 with IDQ > 6. JH patients had higher contractile integral in both phases, and a higher ratio between postpeak to prepeak contractile integral independent of duration. Similarly, JH patients with an IDQ > 6 had higher contractile metrics than those with IDQ ≤ 6. There was a correlation between the IDQ score and the ratio within the postpeak to prepeak contractile integral (r = .375).

Conclusions: Abnormalities in contractile integral of the postpeak phase are more significant in JH with higher dysphagia scores Although the total postpeak contractile integral was higher in symptomatic patients, this was associated with longer duration of postpeak activity suggesting that dysphagia patients with JH have a defect in the postpeak phase of peristalsis.

Keywords: Jackhammer esophagus; contractile integral; swallow.

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Conflict of interest statement

Conflict of interest: John E. Pandolfino [Given imaging (consulting, educational), SandhIll Scientific Inc. (Consulting)]. No other conflicts for remaining authors

Figures

Figure 1
Figure 1
The separation of pre-peak phase and post-peak phase in the peristalsis wave. Legend: A: single-peak swallow; B multiple-peak swallow, the phase from the beginning of the contraction to the first peak was defined as pre-peak phase, otherwise the post-peak phase represented all of the activity beyond this first peak.
Figure 2
Figure 2
The schematic diagram of the novel measurement in the esophageal pressure topography (EPT) Legend: A single swallow was divided into a pre-peak contractile integral (PREP-CI) and a post-peak contractile integral (POSP-CI) phase by plotting the trajectory of the pressure wave peaks at 1-cm intervals. The contractile integral (mmHg●s●cm) at each 1 cm interval before (PREP-CI) and after (POSP-CI) the peak were measured from the transition zone to the proximal aspect of the EGJ. In the swallow displayed, the PREP-CI was 894 mmHg●cm●s and the POSP-CI was 1285 mmHg●cm●s, which made the composite DCI into 2179 mmHg●cm●s.
Figure 3
Figure 3
Examples of two Jackhammer swallows. Legend: A) A single-peak jackhammer swallow with normalized POSP-CI (composite DCI=15237 mmHg●cm●s), the POSP-CI/PREP-CI ratio was 1.56. The POSP-CI-tc/PREP-CI-tc was 0.85 after controlled by the phase duration. B) A multiple-peak jackhammer swallow with prolonged POSP-CI (composite DCI=16502 mmHg●cm●s), the POSP-CI/PREP-CI ratio was 2.93. The POSP-CI/PREP-CI-tc was 1.11 after controlled by the phase duration.
See this image and copyright information in PMC

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