GOALS: The aim of our study was to characterize jackhammer esophagus symptoms 
and their relationship with the distal contractile integral (DCI) and bolus 
transit.
BACKGROUND: Jackhammer esophagus is defined by the Chicago Classification 
version 3.0. This diagnosis is relatively new, with the most current definition 
being established in 2014. The forerunners of this diagnosis, nutcracker (or 
hypercontractile) esophagus, have been associated with noncardiac chest pain 
(NCCP).
STUDY: A retrospective chart review was performed of motility studies from 2011 
to 2016. Studies with a diagnosis of jackhammer esophagus, hypercontractile 
esophagus, nutcracker, esophagogastric junction outflow obstruction, or 
hypertensive lower esophageal sphincter were reread using Chicago Classification 
version 3.0, and were included if they met criteria for jackhammer esophagus. 
Unpaired t-tests were used for analysis (P≤0.05).
RESULTS: In total, 142 studies were identified with the above diagnoses. After 
excluding 84 studies, 58 remained for analysis and 17 were found to have 
jackhammer esophagus (29%). The mean age was 54 (28 to 75), 5 (29%) were males 
and 12 (71%) were females. The primary indications were NCCP (5), dysphagia (8), 
and other causes (4) (cough, heartburn, or regurgitation). The mean DCIs were 
17,245 mm Hg×s×cm (NCCP), 14,669 mm Hg×s×cm (dysphagia), and 11,264 mm Hg×s×cm 
(other causes). The mean DCIs were compared: NCCP versus dysphagia (P=0.41), and 
NCCP versus other causes (P=0.05). Fifteen (88%) had normal bolus transit for 
both liquid and viscous swallows.
CONCLUSIONS: In our small sample size, dysphagia was frequently the presenting 
symptom followed by NCCP. Those with NCCP have a trend toward a higher DCI. 
Bolus transit appeared to be normal in this patient population. More data are 
needed to further elucidate the genesis of symptoms and how they relate to the 
degree of contractility.