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杰克 hammer 食管:患者人口统计学、疾病表现、高分辨率测压数据和治疗结果的荟萃分析。

Jackhammer esophagus: A meta-analysis of patient demographics, disease presentation, high-resolution manometry data, and treatment outcomes.

机构信息

Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada.

出版信息

Neurogastroenterol Motil. 2020 Nov;32(11):e13870. doi: 10.1111/nmo.13870. Epub 2020 May 14.


DOI:10.1111/nmo.13870
PMID:32406556
Abstract

BACKGROUND: Jackhammer esophagus (JE) is a newly described esophageal motility disorder. However, there are limited data on JE and this entity remains misunderstood. METHODS: We performed a systematic review of clinical series on JE through MEDLINE, EMBASE, and Web of Science. Data from included studies were then extracted, and random-effects meta-analyses were performed. RESULTS: Thirty-eight studies met inclusion criteria. The pooled prevalence of JE was 1.97% [95% CI: 1.39%-2.78%] among patients referred for high-resolution manometry (HRM). The mean age at diagnosis was 60.8 years [95% CI: 57.1-64.4] and 65% [95% CI: 58%-72%] of patients were female. JE was significantly more prevalent in postlung transplant patients and morbidly obese patients undergoing HRM (23.99% [95% CI: 9.00%-38.97%] and 5.18% [95% CI: 1.76%-14.3%] respectively). Dysphagia was the most common presentation of JE (64% [95% CI: 52%-77%]) followed by gastroesophageal reflux disease (46% [95% CI: 26%-67%]). The pooled mean distal contractile integral (DCI) of all standard HRM swallows was 9249 mm Hg·s·cm [95% CI: 7834-10 663], and the pooled mean integrated relaxation pressure (IRP) was 13.9 mm Hg [95% CI: 8.2-19.7]. Overall, 73.6% [95% CI: 64.0%-83.1%] of JE patients who underwent treatment achieved clinical symptom improvement (79% [95% CI: 74%-85%] for endoscopic treatment and 63% [95% CI: 47%-79%] for medical treatment). The pooled clinical success rate of peroral endoscopic myotomy (POEM) specifically was 82% [95% CI: 75%-90%]. CONCLUSIONS: JE is a new motility disorder most commonly presenting with dysphagia. High clinical suspicion is important because the diagnosis can only be made through HRM.

摘要

背景:Jackhammer 食管(JE)是一种新描述的食管运动障碍。然而,关于 JE 的数据有限,这种疾病仍然存在误解。

方法:我们通过 MEDLINE、EMBASE 和 Web of Science 对 JE 的临床系列进行了系统评价。然后提取纳入研究的数据,并进行随机效应荟萃分析。

结果:38 项研究符合纳入标准。在接受高分辨率测压(HRM)检查的患者中,JE 的总患病率为 1.97%[95%置信区间:1.39%-2.78%]。诊断时的平均年龄为 60.8 岁[95%置信区间:57.1-64.4],65%[95%置信区间:58%-72%]的患者为女性。JE 在肺移植后患者和接受 HRM 的病态肥胖患者中更为常见(分别为 23.99%[95%置信区间:9.00%-38.97%]和 5.18%[95%置信区间:1.76%-14.3%])。吞咽困难是 JE 最常见的表现(64%[95%置信区间:52%-77%]),其次是胃食管反流病(46%[95%置信区间:26%-67%])。所有标准 HRM 吞咽的平均远端收缩积分(DCI)为 9249mmHg·s·cm[95%置信区间:7834-10663],平均整合松弛压力(IRP)为 13.9mmHg[95%置信区间:8.2-19.7]。总的来说,73.6%[95%置信区间:64.0%-83.1%]接受治疗的 JE 患者实现了临床症状改善(内镜治疗为 79%[95%置信区间:74%-85%],药物治疗为 63%[95%置信区间:47%-79%])。经口内镜肌切开术(POEM)的总体临床成功率为 82%[95%置信区间:75%-90%]。

结论:JE 是一种新的运动障碍,最常见的表现是吞咽困难。高度怀疑该病的存在非常重要,因为只有通过 HRM 才能做出诊断。

相似文献

[1]
Jackhammer esophagus: A meta-analysis of patient demographics, disease presentation, high-resolution manometry data, and treatment outcomes.

Neurogastroenterol Motil. 2020-11

[2]
Jackhammer esophagus: Clinical presentation, manometric diagnosis, and therapeutic results-Results from a multicenter French cohort.

Neurogastroenterol Motil. 2020-11

[3]
Clinical Symptom Presentation of Hypercontractile Peristalsis in the Era of High-Resolution Manometry: A Single-Center Experience.

Dig Dis. 2020-1-29

[4]
Provocative testing in patients with jackhammer esophagus: evidence for altered neural control.

Am J Physiol Gastrointest Liver Physiol. 2018-12-13

[5]
Frequency of Jackhammer Esophagus as the Extreme Phenotypes of Esophageal Hypercontractility Based on the New Chicago Classification.

J Clin Gastroenterol. 2016-9

[6]
Jackhammer Esophagus: From Manometric Diagnosis to Clinical Presentation.

Can J Gastroenterol Hepatol. 2019-3-3

[7]
Esophageal hypermotility: cause or effect?

Dis Esophagus. 2016-7

[8]
Jackhammer esophagus: Observations on a European cohort.

Neurogastroenterol Motil. 2017-4

[9]
Hypercontractile Esophagus From Pathophysiology to Management: Proceedings of the Pisa Symposium.

Am J Gastroenterol. 2021-2-1

[10]
The clinical significance of hypercontractile peristalsis: comparison of high-resolution manometric features, demographics, symptom presentation, and response to therapy in patients with Jackhammer esophagus versus Nutcracker esophagus.

Dis Esophagus. 2017-12-1

引用本文的文献

[1]
Esophageal and Oropharyngeal Dysphagia: Clinical Recommendations From the United European Gastroenterology and European Society for Neurogastroenterology and Motility.

United European Gastroenterol J. 2025-7

[2]
[Sex/Gender Differences in Esophageal Motility Disorders].

Korean J Helicobacter Up Gastrointest Res. 2024-9

[3]
Jackhammer Esophagus as a Complication of Tonsillectomy and Adenoidectomy: A Case Report.

Case Rep Gastroenterol. 2025-1-14

[4]
Peroral endoscopic myotomy for hypercontractile (Jackhammer) esophagus: A retrospective multicenter series with long-term follow-up.

United European Gastroenterol J. 2024-9

[5]
Compartmentalized pressurization is a novel prognostic factor for hypercontractile esophagus.

Neurogastroenterol Motil. 2024-1

[6]
Esophageal Reflux Hypersensitivity: A Comprehensive Review.

Gut Liver. 2023-11-15

[7]
Clinical presentation and therapeutic outcome of patients with jackhammer esophagus-a multicenter cohort study in Japan.

Esophagus. 2022-7

[8]
Morphologic Changes in Esophageal Body Movement During Bolus Transport After Peroral Endoscopic Myotomy in Type III Achalasia.

J Neurogastroenterol Motil. 2022-1-30

[9]
Cricopharyngeal peroral endoscopic myotomy improves oropharyngeal dysphagia in patients with Parkinson's disease.

Endosc Int Open. 2021-11-12

[10]
The hypercontractile esophagus: Still a tough nut to crack.

Neurogastroenterol Motil. 2020-11

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