Post Nissen Jackhammer Esophagus

I’m posting this in hopes it will help others who are having problems getting properly diagnosed and may have this nasty condition.

I had my Laprascopic Nissen Fundoplication surgery and hiatal hernia repair on June 30, 2015. My surgeon is a cardio-thoracic surgeon and came highly recommended. I had a mostly routine recovery based on other success stories I’ve read on these forums.

I was concerned about needing pain meds long after surgery though and I complained about ongoing chest pain in both of my follow-up visits with my surgeon. It wasn’t getting better. I even had two ER visits to rule out blood clots and tests to confirm that my wrap was still secure. I was assured that this was normal and not to worry. I was released from the surgeon’s care on August 17th.

This pain got steadily worse and I could no longer get the narcotic pain meds as I had exhausted the maximum of 3 refills they would give me.

I was told to go see my primary care doctor and a pain clinic. I did both and won’t go into detail, but I couldn’t get anything to manage the pain. The pain clinic referred me to a new gastroenterologist whom I started working with in early October. She had me get Manometry, Esophageal pH study and I just had an endoscopy.

The esophageal pH study revealed that my acid reflux was gone, however, the manometry was totally abnormal and my diagnosis is ‘Jackhammer Esophagus’ and ‘hypertensive LES’. I’ve since learned that this is not easy to diagnose and high resolution manometry is the most accurate test.

To put it mildly, I have been totally miserable. Very little sleep, not much of an appetite and I couldn’t work. Not much of a life and I’m still recovering from surgery. The endoscopy which revealed that my LES was open (a good thing and she didn’t need to dilate) but my wrap is slightly twisted!

I may have to have a re-do but that won’t be decided until my follow-up appointment with gastro doctor mid-December. She will be consulting with my surgeon. I’m not, at this point, blaming him as my research on ‘Jackhammer’ esophagus reveals that two of the possible causes are GERD, stress and anxiety, both of which I’ve had for a LONG time.

My new doctor relayed this information to the pain clinic doctor I had seen and he promptly prescribed 7.5mg. Norco to help manage my pain until my new meds from the gastro doctor kick in.

My gastroenterologist has prescribed Diltiazem 60mg. for the chest pain and to help reset my ‘fried’ pain receptors. Also Amitriptyline 25mg (Elavil). It takes about 3 weeks for these new meds to start giving me relief.

I was hoping to put up a positive post under ‘Successful fundoplication members’, but it has NOT been a successful recovery. I do believe I had this condition even before surgery as I had this chest pain all along but it’s 100 times more painful than it was before surgery. Perhaps the hiatal hernia repair aggrevated this condition. Who knows?

I am very confident of my new gastroenterologist. She is very knowledgeable about my surgery, complications and answered all of my questions. I got so much more from her than my two previous gastro doctors combined. So I believe I’m on the right track and hope to be feeling better soon.

I hope this information will be helpful to someone else.

Yes, Andy1986, I had manometry at a different hospital on 10/31/14 and provided a copy of the report to the surgeon, as well as my new gastro doctor. That was my first manometry and under the 'Impressions' section, I quote:

'Meets minimal criteria for jackhammer esophagus; however, only 1 swallow had distal contractile integral > 8,000 mmHg x cm x s, so the clinical significance of this finding is not certain. There is also possible dysfunction of the upper esophageal sphincter, etc'.

Not sure what this all means, but it was 8 months later that I had surgery and this condition got worse over this time frame.

I don't expect any miracles with the new meds, but since I've been taking them only a couple of days, my sleep has improved greatly. I just had two full nights' sleep without interruption. This morning, I didn't need pain relief until 10am! Pain didn't wake me during the night. The Amitriptyline makes you drowsy and I take it just before bed.

Thanks for your concern, Andy 1986. I am feeling that there is still hope for me. I'm planning to go back to work starting next Tuesday! Really good news for me!

I'm both glad and sad to hear that Linda Sue. Glad to hear you finally know what the problem is, but sad that you might have to go through surgery again. I hope the medication they have you on now can FINALLY give you some relief!

SharonZ,
Wow, sorry to hear about your injury! I hope you're doing better, and yeah, the bubble wrap sounds like a winner!

I had manometry at a different hospital 8 months before my surgery and took a copy of the written report to my surgeon, but he didn't see the actual tracing, but I just figured that the report told him enough so he didn't order a second manometry. My barium swallow and esophageal pH showed significant acid reflux. I'm starting to believe that I had the 'jackhammer' condition for years and it got a lot worse with the surgery. This condition, from what I've read, is hard to diagnose and mimics heart problems as well as acid reflux. Among others it can be caused by GERD and stress/anxiety.

Regarding the slightly twisted wrap, who would know if it happened unless an endoscopy was done? Until I see my gastro doctor again, I won't know where we go from here. I really want to find out if my surgeon messed up but not sure how I can find that out yet. If I do end up needing a 're-do', I will seek out a different surgeon and will discuss this with my new gastro doctor. She's great and knew just what I needed.

I am feeling MUCH better on the new medications and the pain clinic gave me a script for 7.5mg Norco and I'm needing it less and less.

Andy 1986,
The new prescriptions my doctor started me on, I believe work together and after less than a week, I feel so much better. I am down to two pain meds over 24 hours, and no longer need the Xanax, as my mood and frame of mind are greatly improved, as well. I went back to work and felt good all day.

I take the Diltiazem 4x daily to treat chest pain, and one Amitriptyline (Elavil), before bed and I don't need any sleep aids as the Amitriptyline makes one drowsy and I go right to sleep.

Does anyone know: If my surgeon had told me to get a second manometry before my LNF, and it was discovered that I did, indeed, have ‘Jackhammer Esophagus’, would he have still recommended LNF surgery?

(My first manometry was done 10/31/14 and diagnosed ‘meets minimal requirements of jackhammer esophagus). My surgery was done 8 months later and my surgeon never mentioned this and I sent copies of all my records before even meeting with him).

I’ve done a lot of research on this condition and it doesn’t look like there is a cure for it. It is mostly managed with medication. There is, however, a new minimally invasive procedure called POEM (Per Oral Endoscopic Myotomy), but my gastroenterologist doesn’t recommend it because it’s so new, surgeons just don’t have enough experience with it yet and it is most likely, NOT covered by insurance.

I’ve also read about Botox injection in the esophagus during endoscope that offers relief, but is temporary (posted 12/5 by CynMac on these boards).

Is there anyone who has this condition and how is it being treated?