What is Hypercontractile Esophagus?
Hypercontractile esophagus is a rare type of esophageal motility disorder that is characterized by abnormally strong contractions in the esophagus during swallowing.
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Also known as nutcracker or jackhammer esophagus, the esophageal spasms or contractions associated with this condition can cause the following symptoms:
- Pain when swallowing
- Difficulty swallowing
- Chest pain
- GERD symptoms like heartburn
- Dry cough
The exact cause of hypercontractile esophagus is not known but research has shown that it is more likely to occur in people who:
- Are female
- Are over 50 years of age
- Have frequent heartburn
- Have been diagnosed with GERD
Expert Diagnosis and Treatment for Hypercontractile Esophagus
If you are experiencing any of the symptoms listed above, it is important to see a UH digestive health specialist for an accurate diagnosis so that the appropriate treatment can begin. Before your first appointment, it may be helpful to keep a food diary that notes when the spasms occur and if they seem to be related to certain foods.
After completing a physical exam and taking a medical history, your doctor may order one or more of the following diagnostic tests:
- Upper endoscopy
A test that uses a flexible tube called an endoscope to look at the inside of the esophagus. The tube has a light and a camera on the end so the doctor can see changes in the esophagus such as inflammation, infection and other abnormalities.
- Esophageal manometry
A nonsurgical, minimally invasive endoscopic test in which the doctor inserts a long, flexible tube called an endoscope into your esophagus. This highly sensitive instrument can measure and evaluate the muscle strength and contractions in the esophagus.
- Barium esophagram
This test uses barium and X-ray technology to look at the size and shape of your esophagus and how well you swallow.
- Esophageal pH testing
This is a 24-hour test in which a small tube with an acid-sensing device on the end is inserted through your nose and into your esophagus. The tube is attached to a special device that records the acidity of your esophagus as you continue to eat and drink normally.
- Endoscopic ultrasound
A noninvasive procedure that provides detailed information about the muscles and lining of the esophagus.
If your test results suggest you may have hypercontractile esophagus, your treatment plan may include:
- Breathing exercises and techniques to relax your esophagus
- Avoiding foods and/or drinks that bring on symptoms
- Medications such as calcium channel blockers or proton pump inhibitors (PPI)
- Botulinum toxin injections (Botox) to relax your esophagus muscles
- Peroral Endoscopic Myotomy or POEM. The POEM procedure only recently became available in the United States and there are very few centers with more than 10 years of experience in this advanced endoscopic technique. University Hospitals Digestive Health Institute is proud to offer patients this procedure. Jeffrey Marks, MD, general surgeon and Director of Surgical Endoscopy at UH Cleveland Medical Center further explains the procedure in this video.