BACKGROUND/AIMS: Jackhammer esophagus (JE) is a hypercontractile esophageal 
motor disorder defined by at least two swallows with a distal contractile 
integral (DCI) >8000 mm Hg.s.cm during high-resolution manometry (HRM). The 
relationship between symptoms and hypercontractility and the response to 
therapies have been poorly evaluated. The aim of this study was to determine the 
clinical presentation, manometric diagnosis, and therapeutic results in a large 
cohort of JE patients.
METHODS: Patients with JE diagnosed among the HRM tests performed in nine 
academic French centers from 01/01/2010 to 08/31/2016 were included. Patient 
charts were reviewed to collect clinical and therapeutic data.
RESULTS: Among the 16 264 HRM tests performed during this period, 227 patients 
(60.8 ± 13.8 years, 151 male) had JE (1.7%). Dysphagia was the most frequent 
symptom (74.6%), followed by regurgitation (37.1%) and chest pain (36.6%); 4.7% 
of the patients were asymptomatic. The diagnostic workup was heterogeneous, and 
only a minority of patients had esophageal biopsies. None of the individual 
symptoms were significantly associated with any of the manometric parameters 
defined, except for dysphagia, which was significantly associated with the mean 
of all DCIs >8000 mm Hg.s.cm (P = .04). Additionally, the number of symptoms was 
not associated with any manometric parameter. Medical treatment and endoscopic 
treatments had poor efficacy and a high relapse rate.
CONCLUSION: Jackhammer esophagus is a rare motility disorder. Diagnostic workup 
is heterogeneous and should be standardized. Symptoms are poorly associated with 
manometric parameters. The medical treatments and endoscopic therapies currently 
used are inefficient.