title: Hypercontractile esophagus: Clinical context and motors findings in high resolution manometry.
abstract: BACKGROUND
  Hypercontractile esophagus (HE) is a primary hypercontractile disorder of the esophageal musculature not frequently seen in the general population. It is characterized by the presence of at least one contraction with a very high amplitude and duration (DCI > 8,000 mmHg/s/cm) in patients with esophageal symptoms. The aim of our study was to assess the clinical context and manometric characteristics in patients with HE using highresolution manometry (HRM).
  
  
  METHODS
  We thoroughly reviewed the clinical features and manometric findings of a total of 720 patients with esophageal symptoms that were attended in the Department of Gastroenterology of our hospital between June 2011 and June 2013.
  
  
  RESULTS
  We found seven patients that met criteria for HE according to the Chicago Classification (2012). All of the patients were women (100%). Mean age was 64 years old. Most frequent symptoms were: Chest pain, dysphagia and heartburn.In one patient (14%) the HE was related to a gastroesophageal reflux disease (GERD) and gastroesophageal junction (GEJ) outflow obstruction. Three patients (43%) had more than one hypercontractile contraction in the study. Four patient (57%) hade multipeaked pattern (Jackhammer esophagus) and y two of them were synchronized with respiration. Two patients (29%) were diagnosed with hiatus hernias. Integrated relaxation pressure (IRP) was not higher in hypercontractile contractions than in normal contractions. Only one patient presented a slight alteration of the relaxation (IRP-4s = 15 mmHg) with normal peristalsis, GEJ outflow obstruction and not multipeakeded pattern. One patient presented pathological acid exposure (PAE) in 24-hours pH-metry.
  
  
  CONCLUSIONS
  HE is a rare disorder and HRM is essential for its correct diagnosis and characterization. The treatment of HE should achieve the disappearance or at least improvement of the patient´s symptoms and avoid unnecessary diagnostic testing.
authors.forename: Verónica
authors.initials: V
authors.lastname: Martín-Domínguez
authors.forename: María Teresa
authors.initials: MT
authors.lastname: Pérez-Fernández
authors.forename: Almudena
authors.initials: A
authors.lastname: Marinero
authors.forename: Vanesa
authors.initials: V
authors.lastname: Jusué-Irurita
authors.forename: María
authors.initials: M
authors.lastname: Caldas
authors.forename: Cecilio
authors.initials: C
authors.lastname: Santander
mesh_terms: D000368:Aged; D015154:Esophageal Motility Disorders / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008365:Manometry / Q000379:methods; D008875:Middle Aged