A forty year old happily married foreign national, working as a marketing executive in India since 2 years; came complaining about a chest pain, that had been present over the last 2 years. It had started while he was then working in Africa, but gradually built up during his stay in India. He was otherwise fit, would jog daily, would smoke about 5-10 cigarettes a day since the last 20 years, may have an occasional glass of wine.
The chest pain did not follow a typical pattern. Two years ago, it was episodic initially, a low painful bloating behind the chest bone that waxed and waned. He had seen a Physician as well as a Cardiologist then; and was found to have a completely normal heart. The pain would build up over 4-6 hours; then reduce over 10 hours; very like a heart pain, except for the fact that he noticed he had painful swallowing during these hours. In the past year, he noticed that he was short of breath while lying down, but this had become less frequent since the last 6 months.
He had seen a Gastroenterologist and had an endoscopy a year ago; which revealed a reflux too mild to be associated with his severe symptoms; he did not respond to the regular medication for “acidity”anyway. He lost 8 kg in weight as the pain affected his meals. In the last month the pain had become more distracting; twice a week; associated hiccups. He would feel a vise like “block in the chest” and felt better by bringing up some mucus in a belch, only to recur in 20 minutes.
He was offered a special test called Esophageal Manometry. This examines the strength of the wave of “peristalsis”(the contraction wave carrying food down to the stomach). In normal persons, we can identify a ring like contraction pressure wave behind the swallowed food morsel, that leads down at a speed of 8-10 cm every second. In our patient, the esophagus (food pipe) appeared to suddenly go into a tight vise like spasm around just a sip of water, the pressures of which were three times what would be needed for normal peristalsis. These contractions appeared to squeeze at the same point again and again; and continue even when the water had reached the stomach. The patient reported pain when the strength of the contractions were the strongest; thus confirming real time that we have finally identified the real cause of the problem : a Jack Hammer Esophagus. A Jack Hammer is a drilling device which you see with construction workers drilling through concrete; the simile is the high pressure waves hitting at a point repeatedly till it gives away.
Simple oral medication for the next 6 weeks were advised to the patient, which helped relax the muscles and lead to a complete resolution of symptoms. Manometry and Gastrointestinal Physiology Studies are a newly evolving science that is throwing a new light on previously obscure symptoms; some symptoms that could not be explained before are now diagnosed as well as followed till cure.