{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T22:03:53Z","timestamp":1764540233723,"version":"3.41.2"},"reference-count":20,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2018,11,15]],"date-time":"2018-11-15T00:00:00Z","timestamp":1542240000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The most recent Chicago Classification expanded the criteria for diagnosis of jackhammer esophagus (JHE) to include the distal contractile integral (DCI) of the lower esophageal sphincter (LES). The clinical impact of the manometric inclusion of LES hypercontractility remains unclear. We aimed to analyze the clinical features and long\u2010term outcomes of measured LES\u2010dependent (LD\u2010JHE) and LES\u2010independent (LI\u2010JHE) jackhammer esophagus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients meeting diagnostic criteria for JHE were identified at two academic medical centers. High\u2010resolution esophageal manometry data were re\u2010analyzed with inclusion and exclusion of the LES DCI. LD\u2010JHE was defined by falling outside JHE diagnostic criteria with exclusion of the LES. A telephone survey was conducted for follow\u2010up utilizing the impact dysphagia (IDQ\u201010) questionnaire.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Results<\/jats:title><jats:p>Eighty\u2010one patients met study inclusion criteria, with 12 (14.8%) classified as LD\u2010JHE. LD\u2010JHE patients had a significantly lower mean DCI and fewer swallows with DCI &gt;8000\u00a0mm\u00a0Hg\u2010s\u2010cm. Basal LES pressure was higher in patients with dysphagia to solids than those with dysphagia to solids and liquids. Clinical and manometric parameters were otherwise similar between groups. Sixty\u2010six patients had clinical or phone follow\u2010up at a median of 46.6\u00a0months. Forty\u2010one patients (62.1%) received therapies directed at JHE. There was no difference in symptom improvement for treated vs untreated patients or for JHE subtype.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Inferences<\/jats:title><jats:p>Our findings suggest that LD\u2010JHE and LI\u2010JHE are clinically indistinguishable and thus support existing diagnostic criteria. Furthermore, our long\u2010term follow\u2010up data suggest that JHE, irrespective of LES involvement, may improve without treatment. Further study is needed to clarify which patients merit therapeutic intervention.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.13507","type":"journal-article","created":{"date-parts":[[2018,11,16]],"date-time":"2018-11-16T07:01:36Z","timestamp":1542351696000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Clinical features and long\u2010term outcomes of lower esophageal sphincter\u2010dependent and lower esophageal sphincter\u2010independent jackhammer esophagus"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1685-0865","authenticated-orcid":false,"given":"Allon","family":"Kahn","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology Mayo Clinic Scottsdale Arizona"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohanad T.","family":"Al\u2010Qaisi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Mayo Clinic Scottsdale Arizona"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert A.","family":"Obeid","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Mayo Clinic Scottsdale Arizona"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David A.","family":"Katzka","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Mayo Clinic Rochester Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karthik M.","family":"Ravi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Mayo Clinic Rochester Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco C.","family":"Ramirez","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Mayo Clinic Scottsdale Arizona"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael D.","family":"Crowell","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Mayo Clinic Scottsdale Arizona"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcelo F.","family":"Vela","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Mayo Clinic Scottsdale Arizona"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,11,15]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0b013e31815ea291"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2982.2011.01834.x"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12477"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12975"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.13105"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/dote\/dox085"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2015.02.046"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12071"},{"issue":"2","key":"e_1_2_8_10_1","first-page":"101","article-title":"The role of hiatus hernia in GERD","volume":"72","author":"Kahrilas PJ","year":"1999","journal-title":"Yale J Biol Med"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(91)80003-R"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2011.313"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.5009\/gnl15388"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1350-1925.2003.00450.x"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/dote.12282"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0042-105204"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/dote.12182"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2014.11.005"},{"volume-title":"Color Atlas of High Resolution Manometry","year":"2009","author":"Conklin JL","key":"e_1_2_8_19_1"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2005.02.002"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2982.2005.00661.x"}],"container-title":["Neurogastroenterology &amp; 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