What Is a Hypercontractile Esophagus?
Hypercontractile esophagus is a rare hypercontractile esophageal motility disorder. This condition is also known as jackhammer esophagus or nutcracker esophagus. The cause of hypercontractile esophagus is unknown, but there is an association between acid reflux and hypercontractile esophagus. This belongs to a group of conditions related to abnormal movement and function of the esophagus known as motility disorders. While swallowing, the esophagus contracts, and it helps to move food into the stomach. These contractions are much stronger than causing chest pain. The main difference between the esophagus is that it does not cause regurgitation of food or liquid and diffuses esophageal spasms.
What Are the Causes of Hypercontractile Esophagus?
Hypercontractile esophagus is a rare condition. The exact cause is unknown. It can relate to the issues with the muscle function and thickness of the esophagus. For a few individuals, spasm seems to only happen when they eat hot or cold foods. It is common in individuals with gastroesophageal reflux disease.
The following few factors increase hypercontractile esophagus:
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Heartburn.
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Being female.
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Being over 50 years of age.
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Having gastroesophageal reflux disease.
What Are the Signs and Symptoms?
The main symptom of the hypercontractile esophagus is painful swallowing. The following are the symptoms:
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Dry cough.
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Trouble swallowing.
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Dry cough.
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Feeling like something is stuck in the throat.
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Sudden and severe chest pain can last several minutes on and off for hours.
What is the Differential Diagnosis of Hypercontractile Esophagus?
The differential diagnoses of the hypercontractile esophagus are
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Achalasia: A rare disorder that makes it difficult for food and liquid to travel through the stomach.
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GERD (Gastroesophageal Reflux Disease): A common condition that affects elderly people in common, in which the gastric and bile juices irritate the esophageal lining.
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Esophageal Carcinoma: Cancer in the tube that connects the stomach and mouth which carries food and liquid to the stomach.
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Corkscrew Esophagus: It is a classic finding of diffuse esophagus spasm, in barium studies that reflects abnormal contractions. This leads to compartmentalization and curling of the esophageal tube, which gives an appearance like a corkscrew or rosary beads.
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Esophageal Stricture: An abnormal tightening of the esophagus is esophageal stricture, this can limit or block food that travels from throat to stomach.
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Plummer-Vinson Syndrome: A disorder caused by iron deficiency, and a web-like growth of membranes of the throat which makes swallowing difficult. This condition increases the risk of getting esophageal cancer.
How Is the Diagnosis for Hypercontractile Esophagus Made?
A physical examination is a basic exam to rule out any underlying conditions. Keeping a note of symptoms during a week or two:
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A barium swallow involves swallowing a type of dye that will show up on an X-ray.
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Esophageal Manometry: Measures the muscle pressure of the esophagus and any spasm.
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Endoscopy: This procedure involves a small camera to look at the side of the esophagus.
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Esophageal pH Monitoring: Tests for any signs of acid reflux by measuring pH in the esophagus.
What Is the Treatment Provided for Hypercontractile Esophagus?
In most cases, the hypercontractile esophagus is treated with a combination of medication or home remedies. Medications that help with the condition include:
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Calcium channel blockers.
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Anticholinergic drugs.
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Hyoscyamine (Levsin).
Home remedies that help to relax:
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Doing breathing exercises and behavioral techniques for relaxation.
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Food items and drinks that trigger the symptoms should be avoided.
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Drinking warm water.
If medication and home remedies provide relief, additional treatment, such as:
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Surgery to cut one of the muscles in your esophagus to weaken contractions.
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A botulinum toxin (Botox) injection to relax muscles in your esophagus.
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POEM procedure uses an endoscope rather than traditional surgery to cut the back section of muscle within the esophagus.
What Are Potassium Competitive Acid Blockers?
Potassium competitive acid blockers are novel drugs that bind to the potassium ions and block the hydrogen ions. They are acid-suppressant drugs that inhibit gastric ATPase faster than proton pump inhibitors. Potassium competitive acid blockers heal the esophagus and reduce the symptoms in individuals where proton pump therapy fails. Vonoprazan is the first-line potassium competitive acid blocker drug with a more rapid onset of action and longer duration of acid suppression.
How Does Hypercontractile Esophagus Respond to Potassium-Competitive Acid Blockers?
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Potassium competitive acid blockers rapidly, effectively, and reversibly inhibit the proton pump. P-CABs like Imidazopyridine are used, but it is related to hepatic toxicity.
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Vonoprazan fumarate has a different chemical structure and is different from other previous P-CABs. Vonoprazan is highly accumulated in the gastric gland both in resting and active state. In experimental studies, the ratio in the resting gastric gland was higher than actively secreting gastric gland as compared with Lansoprazole.
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Thus, accumulation of Vonoprazan led to a rapid onset of action, accumulation of tubulovesicles in the resting parietal cells, and inactivation of H, K - ATPase. Vonoprazan showed superiority even compared with proton pump inhibitors like Omeprazole and rabeprazole in acid suppression.
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Vonoprazan instantly protonates and remains stable when exposed to acidic conditions; thus, it can accumulate, function, and bind the proton pump of gastric parietal cells in strongly acidic secretory calculi.
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It is effectively absorbed and quickly accumulates in parietal cells.
What Are the Possible Complications of Potassium-Competitive Acid Blockers?
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More acid secretion and more effective acid suppression are needed, and more the effects of Vonoprazan stand. Vonoprazan, in short-term acid suppression, there are no problematic side effects.
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Long-term acid suppression treatment is needed, and side effects such as pneumonia, hypergastrinemia, and small bowel bacterial overgrowth infections may occur.
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The safety and tolerability of Vonoprazan for gastroesophageal reflux disease and NSAIDs associated with upper gastrointestinal secondary ulcer prevention should be evaluated.
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Treatment-emergent adverse events like nasopharyngitis, constipation, upper respiratory tract inflammation, diarrhea, falls, eczema, and gastroenteritis on administering Vonoprazan 10 mg and 20 mg.
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Most treatment-emergent adverse effects are classified as mild in intensity. The long-term safety and efficacy of Vonoprazan are under study.
Conclusion
Hypercontractile esophagus is a rare condition associated with dysphagia, regurgitation, heartburn, and noncardiac chest pain. Potassium competitive acid clockers like Vonoprazan are the best therapy, and the hypercontractile esophagus response is the best to this therapy. It is recommended in cases of non-responsive therapy of proton pump inhibitors.
