A54 ASSOCIATION BETWEEN MEDICATION USE AND JACKHAMMER ESOPHAGUS: A CASE-CONTROL STUDY

Hypercontractile or jackhammer esophagus (JE) is a diagnosis made on high-resolution manometry (HRM), defined by the Chicago Classification of esophageal motility disorders (CC v3.0) as ≥20% of swallows achieving a distal contractile integral (DCI, a standardized metric of contraction pressure over time in the distal esophagus) of >8,000 mmHg-s-cm. It is an uncommon finding which can be associated with dysphagia and chest pain. The pathophysiology of JE remains unknown but may be related to medications in certain cases. The aim of this study was to determine if theuse of specific classes of medications, based on mechanism of action, are associated with JE, compared to normal controls. We hypothesized a significantly higher use of opioids in our JE group. Consecutive HRM studies from November 2013 to September 2018 with a diagnosis of JE were compared to control patients with symptoms who had normal HRM. A complete list of all medications taken at the time of HRM was obtained by the nurse immediately prior to the motility study. Odds ratios for each class of medication comparing JE patients to healthy controls were calculated using Pearson chi-square tests. Multiple linear regression was used to identify medication classes which were predictive of DCI. IRB-approved study. 39 JE and 127 control patients were included. The average age was 57 for JE and 52 for controls (P=0.274). 59% of JE and 68% of controls were female (P=0.060). The JE patients’ primary complaints were dysphagia (51%), chest pain (26%), cough (8%), heartburn (8%), food bolus (3%), wheezing (3%), and regurgitation (3%). The mean DCI was 7,139 mmHg-s-cm in the JE group and 1,285 mmHg-s-cm in the control group (P<0.001). Significantly more patients with JE were using inhaled anticholinergics (OR 9.158, P=0.002), inhaled glucocorticoids (OR 4.461, P=0.035), and long-acting beta-agonists (OR 10.561, P<0.001), compared to controls. A borderline association was seen with opioid narcotic use between the two groups (OR 3.285, P=0.070). Long-acting beta-agonists and age were associated with higher DCI on linear regression. The odds of patients taking inhaled asthma medications were higher in patients with JE compared to normal controls. This unexpected finding has been demonstrated in other literature but is due to an as yet unidentified mechanism. Odds were higher for opioid-use in JE but was not statistically significant. Further study of medication effects on esophageal motility is warranted. None

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.