BACKGROUND/AIMS: Jackhammer esophagus is an uncommon heterogeneous motility 
disorder associated with a distal contractile integral > 8000 mmHg∙sec∙cm. The 
spectrum of abnormality ranges from a relatively normal looking contraction to 
chaotic repetitive contractions akin to a jackhammer. Although previous studies 
have shown an uncertain correlation between peristaltic vigor and symptoms, we 
hypothesize that symptoms may be more severe with repetitive contractions as 
opposed to an elevated contractile measure. Thus, this study aims to investigate 
whether symptom severity is related to the contraction pattern in the patients 
with hypercontractile esophagus.
METHODS: Patients with hypercontractile esophagus were retrospectively 
identified, their demographic and high-resolution manometry characteristics were 
collected. Contraction pattern on high-resolution manometry was categorized into 
single-peak and multiple-peak. Comparison was performed between patients with 
single-peak and multiple-peak.
RESULTS: Altogether 35 patients (age range, 45-70 years; female:male, 24:11) 
were included. Seven patients presented with single-peak hypercontractile 
swallows, while 28 patients presented with multiple-peak hypercontractile 
swallows. The patients with multiple-peak showed higher Brief Esophageal 
Dysphagia Questionnaire scores compared with patients with single-peak. The 
jackhammer swallows with multiple-peak were associated with higher distal 
contractile integral values, longer distal latency intervals, and a lower 
integrated relaxation pressure.
CONCLUSIONS: Repetitive contractions akin to a jackhammer were common amongst 
patients with hypercontractile esophagus. Patients with the jackhammer pattern 
also presented with more severe symptoms. Further distinction of 
hypercontractile esophagus into a jackhammer dominant subtype may be warranted.