{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 2, Ep 3 of 4: Spasm and Hypercontractile","html":"","width":"100%","height":180,"duration":474,"description":"Once achalasia is off the table, a normal IRP sends you into the body of the esophagus, which can only fail two ways: too much or too little. This episode is the too-much side: distal esophageal spasm and hypercontractile jackhammer. Both hinge on a normal IRP, both require symptoms to count, and both must clear secondary causes before earning the word diagnosis.\n \nTopics covered\n\nNormal IRP moves the problem into the esophageal body\nDistal esophageal spasm: short distal latency under 4.5 seconds\nJackhammer: DCI over 8000 on a fifth of swallows\nSymptoms required or the pattern is inconclusive\nType three achalasia as the mirror-image trap\nSecondary mimics: opioids, reflux, EoE, mechanical obstruction\nStepwise treatment: smooth muscle relaxants then neuromodulators\n \n \nKey decisions\n\nA normal IRP keeps you out of achalasia and points into the body\nDistal latency under 4.5 seconds on a fifth of swallows defines spasm\nDCI over 8000 on a fifth of swallows defines the hypercontractile jackhammer pattern\nPremature contraction with an elevated IRP is type three achalasia, not spasm\nOpioids raise DCI and shorten latency, so stop the drug and restudy before any procedure\nEndoscopy with biopsies comes first to exclude EoE and mechanical obstruction\n \n \nThis is an AI-generated podcast, and some pronunciations may be imperfect. Thank you for your understanding, and we hope you enjoyed this content.\n \n \nStudy the full chapter on Board Pearls, with practice questions, tables and primary-guideline references: Esophageal Motility\nRead this episode: boardpearls.com/gi/episodes/esophageal-motility-ep3\nQuestions or feedback: hello@boardpearls.com.","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}