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: 
12 Apr 2021
Reviewer's report:
Summary
"Corkscrew esophagus an uncommon finding on upper gastrointestinal
endoscopy in Jackhammer esophagus: a case report" reported a typical case of
Jackhammer esophagus with corkscrew appearance on endoscopy and
esophagogram. Although it is an interesting case, it is not so rare. In addition,
some explanations were not appropriate.
Major comments
1. Although the corkscrew esophagus is often seen in patients with distal
esophageal spasm (DES), it is not specific only in patients with DES. It is
sometimes seen in patients with Jackhammer esophagus (JH) as well as DES.
2. An explanation "JH can be diagnosed if integrated relaxation pressure (IRP) is
greater than the upper limit of the normal range" is wrong. In the Chicago
classification v3.0 it is noted that hypercontractile esophagus can be a
manifestation of outflow obstruction as evident by instances in which it occurs in
association with an IRP greater than the upper limit of normal. It means that JH
can be seen as a result of esophago-gastric junction (EGJ) obstruction.
Therefore, this case should be diagnosed as EGJ outflow obstruction with
hypercontractile esophagus.
3. In the first sentence "JH is defined as normal esophageal peristaltic
contractions with extremely elevated amplitude" was not appropriate. The
hypercontractile contraction is not normal. It should be noted appropriately.
4. Why was proton pump inhibitor prescribed? There was no evidence of
gastroesophageal reflux disease.
5. The new Chicago classification v4.0 has been published. Thus, the new
Chicago classification v3.0 is wrong.
6. I think that a clinical course, in which a calcium blocker was effective, is
important. Invasive treatments, such as POEM, are often selected in such case;
however, non-invasive treatment should be selected as the first choice. Authors
should focus on this aspect except of corkscrew appearance since corkscrew
appearance is not so rare. 
7. The conclusion in the abstract was not appropriate. It should be changed.
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