A298 JACKHAMMER ESOPHAGUS: FROM MANOMETRIC DIAGNOSIS TO CLINICAL PRESENTATION
Bibliographic record
Abstract
Jackhammer esophagus is an hypercontractile esophageal disorder recently brought to light with the advent of high resolution manometry (HRM). As Jackhammer esophagus is purely a manometric diagnosis, little is known about its clinical expression. We hypothesized that the extreme esophageal contractions encountered in this disease cause upper digestive symptoms such as dysphagia and chest pain. Thus, the aim of our study was to identify the clinical characteristics associated with this new motility disorder. A retrospective observational study was conducted from January 2015 to September 2017 at the CHUM gastro-intestinal motility center. Among all the HRM performed, patients with a diagnosis of jackhammer esophagus were included. This diagnosis is made when at least 20% of the swallows being studied are hypercontractile, with a distal contractile integral (DCI) of >8000 mmHg.s.cm (Chicago classification). Each patient’s chart was reviewed to collect clinical data: age, sex, comorbidities, proton pump inhibitor use, along with manometry, upper digestive endoscopy, biopsies, pH-monitoring and barium swallow results. Among the 1046 HRM done during the study period, 34 patients with jackhammer esophagus were included (mean age 62 ± 13 years, 88% females). Their main symptoms were dysphagia (71%), pyrosis (44%), retrosternal chest pain (38%) and epigastralgia (32%). In half of the patients, at least 50% of swallows were hypercontractile. The mean DCI of the hypercontractile esophageal contractions was 11 600 ± 3600 mmHg.s.cm. Other HRM findings were hypertonia (26%) and/or inadequate relaxation (29%) of the lower esophageal sphincter. Upper digestive endoscopy results were available for 26 patients: 18 normal, 3 hiatal hernias, 2 esophageal dilatations, 2 lower esophageal sphincter hypertonia impressions and one with longitudinal striae. Among the 12 available biopsy results, 2 were abnormal: one lymphocytic exostosis and one esophagitis without eosinophilia. Pathological gastro-esophageal reflux was found in 3 of the 9 patients investigated with pH-monitoring. Among the 8 patients who had a barium swallow, 4 had a normal study, 3 had spastic contractions of the esophagus and one had an incomplete relaxation of the cricopharyngeal muscle. Jackhammer esophagus was diagnosed in 3% of the patients referred for a HRM to our gastro-intestinal motility center. A strong female predominance is found in this study. In more than two thirds of cases, the clinical presentation of jackhammer esophagus is dysphagia. Malfunctioning of the lower esophageal sphincter can be demonstrated during manometry. Upper digestive endoscopy and biopsies seem unhelpful in suspecting the diagnosis before HRM is performed. None
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".