{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T10:08:38Z","timestamp":1790762918109,"version":"4.1.0"},"reference-count":28,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2019,7,16]],"date-time":"2019-07-16T00:00:00Z","timestamp":1563235200000},"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":[[2019,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Esophageal hypercontractility can manifest with and without esophagogastric junction (EGJ) outflow obstruction. We investigated clinical presentations and motility patterns in patients with esophageal hypercontractile disorders.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Esophageal HRM studies fulfilling Chicago Classification 3.0 criteria for jackhammer esophagus (distal contractile integral, DCI &gt;8000\u00a0mmHg.cm.s in\u00a0\u2265\u00a020% swallows) with (n<jats:italic>\u00a0=\u00a030<\/jats:italic>) and without (n<jats:italic>\u00a0=\u00a083<\/jats:italic>) EGJ obstruction (integrated relaxation pressure, IRP\u00a0&gt;\u00a015\u00a0mm\u00a0Hg) were retrospectively reviewed from five centers (4 in Europe, 1 in US). Single swallows (SS) and multiple rapid swallows (MRS) were analyzed using HRM software tools (IRP, DCI, distal latency, DL); MRS: SS DCI ratio &gt;1 defined contraction reserve. Comparison groups were achalasia type 3 (n\u00a0=\u00a072, positive control for abnormal inhibition and EGJ obstruction) and healthy controls (n\u00a0=\u00a018). Symptoms, HRM metrics, and MRS contraction reserve were analyzed within jackhammer subgroups and comparison groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Results<\/jats:title><jats:p>The esophageal smooth muscle was excessively stimulated at baseline in jackhammer subgroups, with lack of augmentation following MRS identified more often compared with controls (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.003) and type 3 achalasia (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.07). Consistently abnormal inhibition was identified in type 3 achalasia (47%), and to a lower extent in jackhammer with obstruction (37%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.33), jackhammer esophagus (28%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.01), and controls (11%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.01 compared with type 3 achalasia). Perceptive symptoms (heartburn, chest pain) were common in jackhammer esophagus (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.01 compared with type 3 achalasia), while transit symptoms (dysphagia) were more frequent with presence of EGJ obstruction (<jats:italic>P<\/jats:italic>\u00a0\u2264\u00a0.01 compared with jackhammer without obstruction).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and inferences<\/jats:title><jats:p>The balance of excessive excitation and abnormal inhibition defines clinical and manometric manifestations in esophageal hypercontractile disorders.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.13678","type":"journal-article","created":{"date-parts":[[2019,7,16]],"date-time":"2019-07-16T15:35:01Z","timestamp":1563291301000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Jackhammer esophagus with and without esophagogastric junction outflow obstruction demonstrates altered neural control resembling type 3 achalasia"],"prefix":"10.1111","volume":"31","author":[{"given":"Farhan","family":"Quader","sequence":"first","affiliation":[{"name":"Division of Gastroenterology Washington University School of Medicine St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8475-5464","authenticated-orcid":false,"given":"Aurelio","family":"Mauro","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology and Transplantation Universit\u00e0 degli Studi di Milano Milan Italy"},{"name":"Gastroenterology and Endoscopy Unit Fondazione IRCCS C\u00e0 Granda, Ospedale Maggiore Policlinico Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edoardo","family":"Savarino","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology University of Padua Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1653-9903","authenticated-orcid":false,"given":"Salvatore","family":"Tolone","sequence":"additional","affiliation":[{"name":"General, Mini\u2010Invasive and Bariatric Surgery Unit University of Campania \u201cLuigi Vanvitelli\u201d Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"de Bortoli","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Translational Research and New Technology in Medicine and Surgery University of Pisa, Cisanello Hospital Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianna","family":"Franchina","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology and Transplantation Universit\u00e0 degli Studi di Milano Milan Italy"},{"name":"Gastroenterology and Endoscopy Unit Fondazione IRCCS C\u00e0 Granda, Ospedale Maggiore Policlinico Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Ghisa","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology University of Padua Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krista","family":"Edelman","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Duke University Durham NC USA"},{"name":"Richmond Gastroenterology Associates Richmond VA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lokesh K.","family":"Jha","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine University of Nebraska Medical Center Omaha NE USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6918-9479","authenticated-orcid":false,"given":"Roberto","family":"Penagini","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology and Transplantation Universit\u00e0 degli Studi di Milano Milan Italy"},{"name":"Gastroenterology and Endoscopy Unit Fondazione IRCCS C\u00e0 Granda, Ospedale Maggiore Policlinico Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3388-0660","authenticated-orcid":false,"given":"C. 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