Hypercontractile Esophagus: Clinical Presentation, Role of Provocative Tests in High Resolution Manometry and Long Term Outcome‐Results From an Asian Cohort

ABSTRACT Background Hypercontractile esophagus (HE) is rare. Esophageal high‐resolution manometry (HRM) with solid test meal (STM) in Chicago Classification (CCv4.0) may improve diagnostic yield, but outcome data are lacking. Aim Evaluate the clinical features and long‐term outcome of HE, and determine the clinical significance of hypercontractility detected only using STM. Methods Single‐center analysis of all patients with ≥ 2 hypercontractile swallows (HS) (distal contractile integral [DCI] > 8000 mmHg.s.cm) on HRM studies with single water swallows (SWS) and/or STM between June 2014 and December 2021. A telephone survey was conducted between January and June 2023 using Impaction Dysphagia Questionnaire [IDQ], Eckardt scores, and the Gastro‐Esophageal Reflux Disease Questionnaire (GERD‐Q) to determine long‐term outcomes. Results Forty‐eight patients (29 [60.4%] Female, 63.0 [13.4] years) with HS who presented with dysphagia (60%), reflux (37.5%) and chest pain (29.2%) and 58 controls (28 [48.3%] Female, 49 [13.4] years) with dysphagia ( n = 43.1%), reflux ( n = 41.4%) and chest pain (15.5%) with normal HRM findings were identified from 454 studies performed. More patients had HS with STM versus SWS ( n = 41 [85.4%] vs. n = 7 [14.6%], p < 0.001). Dysphagia was significantly associated with mean DCI ( B = 0.000, p = 0.035) and maximal DCI ( B = 0.000, p = 0.036) during STM. 43% ( n = 3/7) and 22% ( n = 9/41) of patients with ≥ 2 HS using SWS and STM respectively were on medical therapy at mean (SD) clinic follow‐up of 28.7 (29.2) months. At mean (SD) follow‐up telephone survey of 61.3 (27.1) months from HRM, symptom scores amongst 36/48 (75%) patients and 58 controls were: IDQ (3.8 [0–4] vs. 1.0 [0–1.3], p = 0.03); Eckardt dysphagia score (0.46 [0.0–1.0] vs. 0.14 [0–0], p = 0.007); GerdQ (6.4 [6.0–6.0] vs. 7.0 [6.0–8.0], pNS) respectively. Conclusions STM enhanced diagnostic yield of HS and identified more patients who benefitted from medical therapy.