BACKGROUND: Jackhammer Esophagus is defined as intact esophageal peristaltic 
contractions with extremely elevated amplitudes. We conducted a retrospective 
study to identify the frequency of esophageal hypercontractility and the 
clinical characteristics of Jackhammer Esophagus.
METHODS: Charts for the patients referred for manometric study at a 
tertiary-care motility center were reviewed. Data were collected utilizing the 
new Chicago classification criteria for Jackhammer Esophagus. Concomitant 
clinical variables were also explored.
RESULTS: Eight patients were identified with Jackhammer Esophagus from a total 
of 205 (127 female/77 male) patients referred for high-resolution esophageal 
manometry. Jackhammer patients had an average distal contractile integral (DCI) 
of 9061 mmHg/ sec/ cm and median maximal DCI of 16,433 mmHg/ sec/ cm. The 
greatest DCI from 15 swallows was 28,875 mmHg/ sec/ cm. Hypercontractility was 
associated with multipeaked contractions in every Jackhammer patient. The mean 
lower esophageal sphincter (LES) pressure was 41 mm Hg with 4 patients having a 
hypertensive pressure of >40 mm Hg. Three of the 8 (37.5%) Jackhammer group had 
incomplete LES relaxation by integrated relaxation pressure criteria (>15 mm Hg 
residual pressure). Dysphagia (8/8) was the dominant indication for the 
manometric study, whereas the clinical background setting was gastroesophageal 
reflux disease (4/8) and hiatal hernia (1/8). Treatments included smooth muscle 
relaxation, antireflux regimens, and pneumatic dilation of the LES.
CONCLUSIONS: Jackhammer Esophagus, an extreme manometric phenotype, was 
identified in 4.0% of patients referred to a University Motility Center. The 
patients with these esophageal hypercontractility states present mainly with 
dysphagia. A subgroup of Jackhammer did have accompanying incomplete LES 
relaxation and responded to targeted therapy with pneumatic dilatation.