Balloon against Jackhammer Disorder
A 37-year-old woman was referred to the hospital in November 2012 for dysphagia. The patient had been experiencing thoracic pain and dysphagia for solids for 6 months and lost 20 kg. She had no prior medical history, was not taking any medication and did not smoke.\nEsogastroduodenal endoscopy with biopsy was normal, excluding eosinophilic esophagitis. Echoendoscopy and thoracic CT scan were also normal, with no muscular thickening and no mediastinal tumor. Esogastroduodenal transit did not show any esophageal dilatation. HRM (Sierra Given) was performed. The catheter was placed transnasally and positioned to obtain recordings from the hypopharynx to the stomach with 36 circumferentially sensitive sensors. The catheter was attached to the nose. The transducers were calibrated. The HRM protocol included at least one 30 s assessment of basal sphincter pressure and ten 5 ml water swallows in a supine position. Esogastric junction pressure was 32 mm Hg (normal <43) and integrated relaxation pressure (IRP) 20 mm Hg (normal <15), showing impaired relaxation after swallowing. The mean distal contractile integral (DCI) was 8,063 mm Hg cm s and the contractile front velocity was 74.3 cm/s (normal <6.3). Intrabolus pressure was high at 10 mm Hg (normal <8.4), suggesting esophageal stasis.\nBased on these results, pneumatic dilatation was performed with a Rigiflex balloon (Boston Scientific) positioned at the esogastric junction. The balloon was inflated to 30 mm 5 PSI for 1 min and 8 PSI for 1 min. Three months after endoscopy, the patient described clinical improvement with only two episodes of dysphagia, no chest pain, no regurgitation and weigh gain. HRM showed an esogastric junction pressure of 25 mm Hg (normal <43), IRP 12 mm Hg (normal <15), mean DCI 2,514 mm Hg cm s and normal peristalsis. The patient had no symptoms at 6 months.