Review for 10.1186/s12876-021-01808-3 (2021)

Reviewer’s report
Title: 
Manometrically Jackhammer Esophagus with
Fluoroscopically/Endoscopically Distal Esophageal Spasm: a Case Report
Version: 
0 
Date: 
28 Mar 2021
Reviewer: 
Nobuo Omura
Reviewer's report:
This is an uncommon case of manometrically Jackhammer esophagus with
fluoroscopically/endoscopically diffuse esophageal spasm (DES). I have some
questions.
1. Endoscopic and upper gastrointestinal X-ray findings closely resemble DES. I
myself have never experienced such findings in Jackhammer esophagus cases.
Why did you diagnose with a Jackhammer esophagus rather than a DES? Is
manometric diagnosis superior to diagnosis based on esophagogram and
endoscopy? I recommend that this case should be expressed as manometrically
Jackhammer esophagus with fluoroscopically/endoscopically DES. Title and
body of this manuscript should be revised accordingly.
2. Esophageal motility disorders are usually refractory to medications.
Dysphagia score (eg, Eckardt score) before and after treatment should be
described to clarify effect of medication.
3. If medications can relieve his symptoms, is there any change of fluoroscopic
findings between pre- and post-medication therapy? Show esophagogram
pictures post-treatment.
4. On line 99-100, you described that "other possible diagnoses should be kept
in mind before the disease has been confirmed by HRM". This is not convincing.
Why do you need to distinguish whether jackhammer or DES, if treatment
strategy of Jackhammer esophagus is same as that of DES?
5. You should also include the median with interquartile range for DL and DCI.
6. Barium esophagogram and endoscopic findings do not show any obvious
sliding hiatal hernia, so please delete the description.
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