Hypercontractile esophagus, also known as jackhammer esophagus, is a rare condition where you experience strong, repetitive spasms in your esophagus.

Hypercontractile esophagus is a motility disorder in which there is abnormal movement and function of the esophagus.

When you swallow, your esophagus contracts involuntarily to help move food through your digestive tract, a process known as peristalsis.

If you have hypercontractile esophagus, however, these contractions:

  • are much stronger
  • happen in a frequent and repetitive manner
  • have a lot of pressure

Esophagus motility disorders are classified using the Chicago Classification. As of April 2024, the most recent version of the Chicago Classification is the fourth, published in 2020.

Hypercontractile esophagus occurs when 20% of your esophageal contractions have a distal contractile integral (DCI) of more than 8000 mm Hg cm/s. DCI calculates the force, length, and duration of esophageal contractions.

Keep reading to learn more about the symptoms and treatments of hypercontractile esophagus.

What is nutcracker esophagus?

“Nutcracker” esophagus is a term no longer used in clinical settings. It referred to an esophageal contraction greater than 180 mm Hg when measured using conventional manometry.

Over the past 30 years, however, motility disorders have been diagnosed using high-resolution manometry, which uses the DCI calculation.

The term “hypercontractile esophagus” has replaced “nutcracker esophagus.”

The most common symptoms of hypercontractile esophagus are chest pain and dysphagia (trouble swallowing).

Other symptoms that may also occur with hypercontractile esophagus include:

The exact cause of hypercontractile esophagus is unknown.

However, researchers have identified several risk factors that may be associated with the condition, including:

A 2022 review found that spinal injury, hiatal hernia, and vagus nerve problems may also have a link with hypercontractile esophagus.

The type of hypercontractile esophagus you have will depend on which part of the esophagus is affected.

There are three types:

  • Esophaegul body: This type affects only the main body of the esophagus.
  • LES involvement: The lower esophageal sphincter (LES) helps protect foods and acids from coming back up your esophagus. Sometimes, hypercontractile esophagus will affect the LES.
  • LES only: In rare cases, hypercontractile esophagus only affects the LES.

Hypercontractile esophagus is diagnosed using high-resolution manometry. This can also help determine the type of hypercontractile esophagus you have.

To rule out other possible conditions, a healthcare professional may also perform other tests, such as:

Several oral and injection treatment options may help reduce symptoms of hypercontractile esophagus, such as:

Sometimes, a healthcare professional may recommend surgery to cut one of the muscles in your esophagus to weaken contractions. This may include peroral endoscopic myotomy (POEM), which uses an endoscope rather than traditional surgery to cut back a section of muscle within the esophagus.

However, research on treating hypercontractile esophagus is limited, and more research is needed to establish the best treatment.

What is the difference between jackhammer esophagus and diffuse esophageal spasm?

Jackhammer esophagus and diffuse esophageal spasm both affect the esophagus, causing chest pain and swallowing difficulties. However, jackhammer esophagus involves intense, high-pressure contractions, while diffuse esophageal spasm is characterized by uncoordinated contractions.

What triggers esophageal spasms?

The exact cause of esophageal spasms is unknown. However, eating very hot or cold foods may cause spams, as well as having medical conditions like GERD and hiatal hernia.

How do you calm down esophageal spasms?

Some ways to quickly calm an esophageal spasm include taking nitroglycerin or calcium channel blockers. If your symptoms persist, a healthcare professional may recommend other medical treatments or surgery.

Hypercontractile esophagus is a rare condition that happens when your esophagus contractions are stronger and last longer than normal.

Some treatment methods may help you manage symptoms, but more research is needed.

If you experience any symptoms, speak with a healthcare professional. They can provide a proper diagnosis and develop a treatment plan that’s right for you.