Evaluating esophageal motility beyond primary peristalsis: Assessing esophagogastric junction opening mechanics and secondary peristalsis in patients with normal manometry

2021 ◽  
Author(s):  
Dustin A. Carlson ◽  
Alexandra J. Baumann ◽  
Erica N. Donnan ◽  
Amanda Krause ◽  
Wenjun Kou ◽  
...  
Keyword(s):  
Esophageal Motility ◽  
Esophagogastric Junction ◽  
Primary Peristalsis ◽  
Secondary Peristalsis

Esophagus in rumination

1964 ◽  
Vol 207 (6) ◽  
pp. 1189-1194 ◽  
Author(s):  
Daniel H. Winship ◽  
F. Frank Zboralske ◽  
William N. Weber ◽  
Konrad H. Soergel
Keyword(s):  
Pressure Difference ◽  
Esophageal Motility ◽  
Motor Response ◽  
Initial Pressure ◽  
Primary Peristalsis ◽  
Balloon Distention ◽  
Esophageal Sphincter ◽  
Secondary Peristalsis ◽  
Contraction Wave ◽  
Pressure Plateau

Esophageal motility studies of deglutition and rumination were performed in two sheep, two goats, and one calf. The esophageal motor response to balloon distention was investigated in the two sheep. Deglutition and rumination were studied cinefluorographically in the two sheep and one goat. All animals had a ruminoesophageal pressure difference of from 3 to 8 mm Hg, but none exhibited an inferior esophageal sphincter. Primary peristalsis progressed at a rate of 23.5–27.5 cm/sec. Secondary peristalsis was present only in the distal 10 cm of the esophagus, and only distal to the distending balloon. Rumination, unrelated to respiration, produced an initial pressure plateau interpreted as ruminoesophageal reflux, terminating in a contraction wave which was frequently of retrograde peristaltic character in the sheep and calf, traveling at rates averaging 42.5 and 53.8 cm/ sec in the sheep, 112.5 cm/sec in the calf. Rumination begins with ruminoesophageal reflux, facilitated by the ruminoesophageal pressure difference and absence of the inferior esophageal sphincter. The bolus is frequently carried toward the mouth by retrograde peristalsis.

Comparison of primary and secondary esophageal peristalsis in humans: effect of atropine

1991 ◽  
Vol 260 (1) ◽  
pp. G52-G57 ◽  
Author(s):  
W. G. Paterson ◽  
T. T. Hynna-Liepert ◽  
M. Selucky
Keyword(s):  
Neural Pathways ◽  
Esophageal Peristalsis ◽  
Healthy Male ◽  
Double Blind ◽  
Primary Peristalsis ◽  
Lower Amplitude ◽  
Catheter System ◽  
The Subject ◽  
Esophageal Sphincter ◽  
Secondary Peristalsis

To determine whether physiological differences exist between primary (swallow-induced) and secondary (distension-induced) peristalsis in humans, 10 healthy male volunteers underwent esophageal manometry on 2 consecutive days using a perfused intraluminal catheter system that incorporated a latex balloon. Initially the catheter was positioned so that the balloon was centered 16 cm above the lower esophageal sphincter (LES), and intraluminal pressures were recorded 21, 11, 6, and 1 cm above the LES. After a series of wet swallows, dry swallows, and balloon distensions, the catheter was repositioned so that the balloon was 6 cm above the LES and pressures were recorded 1 and 11 cm above the LES. A series of balloon distensions were repeated in this position, and the subject was then given either atropine (10 micrograms/kg iv) or placebo in a double-blind randomized fashion (on consecutive days). The protocol was then repeated in reverse order. Distension-induced responses aboral to the balloon with the balloon located 16 cm above the LES were 1) of lower amplitude, 2) more often nonperistaltic, and 3) less atropine sensitive than swallow-induced contractions at comparable sites. With the balloon located distally (6 cm above LES) contractions induced at the 11-cm site (i.e., orad to the balloon) were much more atropine sensitive than contractions induced at the same site when the balloon was located proximally (i.e., 16 cm above LES). These data suggest that, contrary to previous reports, secondary peristalsis differs significantly from primary peristalsis. Furthermore, atropine differentially effects these two types of peristalsis, suggesting that the neural pathways involved are dissimilar.

Tu1412 IMPACT OF INEFFECTIVE ESOPHAGEAL MOTILITY ON SECONDARY PERISTALSIS IN GERD: STUDIES WITH HIGH RESOLUTION MANOMETRY

2020 ◽  
Vol 158 (6) ◽  
pp. S-1095-S-1096
Author(s):  
Wei-Yi Lei ◽  
Jen-Hung Wang ◽  
Ming-Wun Wong ◽  
Chih-Hsun Yi ◽  
Tso-Tsai Liu ◽  
...  
Keyword(s):  
High Resolution ◽  
Esophageal Motility ◽  
High Resolution Manometry ◽  
Ineffective Esophageal Motility ◽  
Secondary Peristalsis

Absence of a deglutitive inhibition equivalent with secondary peristalsis

2005 ◽  
Vol 288 (4) ◽  
pp. G671-G676 ◽  
Author(s):  
John E. Pandolfino ◽  
Guoxiang Shi ◽  
Qing Zhang ◽  
Peter J. Kahrilas
Keyword(s):  
Smooth Muscle ◽  
Lower Esophageal Sphincter ◽  
Intrinsic Property ◽  
Air Injection ◽  
Success Rates ◽  
Primary Peristalsis ◽  
No Inhibition ◽  
Lower Esophageal Sphincter Relaxation ◽  
Esophageal Sphincter ◽  
Secondary Peristalsis

This study aimed to determine the interactions between closely paired swallow-induced primary peristalsis (PP) and air injection-induced secondary peristalsis (SP). Ten subjects (7 men, 18–42 yr) were studied using a catheter, including two sleeves (upper and lower esophageal sphincters), a midesophageal infusion port, and seven esophageal and two pharyngeal recording sites. Ten iterations of PP and SP were induced by 5-ml water swallows and 20-ml intraesophageal air injections, respectively. Thereafter, the interactions between PP and SP, separated by 1- to 12-s intervals, were studied in all four possible sequences: paired swallows, swallow preceded by air injection, air injection preceded by swallow, and paired air injections. Tracings were analyzed for lower esophageal sphincter relaxation, presence and integrity of peristalsis, and event interaction. Eight subjects with success rates of both ≥90% PP and ≥80% SP were analyzed (PP 97 ± 2%, SP 90 ± 3%). During paired PP interactions and SP followed by PP, the first sequence was inhibited by the second with intervals < 4–6 s. However, no inhibition of the first peristaltic sequence was found in either PP followed by SP trials or SP followed by air injection. In contrast to swallowing or proximal esophageal distention, air injection into the lumen of the midesophagus does not inhibit an ongoing peristaltic event. Being that the elicitation of SP in the smooth muscle esophagus is intramurally mediated, this suggests that deglutitive inhibition is a centrally mediated phenomenon rather than an intrinsic property of peristalsis.

scholarly journals Characterization and mechanism of the esophago-esophageal contractile reflex of the striated muscle esophagus

2019 ◽  
Vol 317 (3) ◽  
pp. G304-G313 ◽  
Author(s):  
Ivan M. Lang ◽  
Bidyut K. Medda ◽  
Reza Shaker
Keyword(s):  
Nervous System ◽  
Smooth Muscle ◽  
Vagus Nerve ◽  
Enteric Nervous System ◽  
Esophageal Motility ◽  
Striated Muscle ◽  
Cervical Esophagus ◽  
Proximal Esophagus ◽  
Secondary Peristalsis

An esophago-esophageal contractile reflex (EECR) of the cervical esophagus has been identified in humans. The aim of this study was to characterize and determine the mechanisms of the EECR. Cats ( n = 35) were decerebrated, electrodes were placed on pharynx and cervical esophagus, and esophageal motility was recorded using manometry. All areas of esophagus were distended to locate and quantify the EECR. The effects of esophageal perfusion of NaCl or HCl, vagus nerve or pharyngoesophageal nerve (PEN) transection, or hexamethonium administration (5 mg/kg iv) were determined. We found that distension of the esophagus at all locations activated EECR rostral to stimulus only. EECR response was greatest when the esophagus 2.5–11.5 cm from cricopharyngeus (CP) was distended. HCl perfusion activated repetitively an EECR-like response of the proximal esophagus only within 2 min, and after ~20 min EECR was inhibited. Transection of PEN blocked or inhibited EECR 1–7 cm from CP, and vagotomy blocked EECR at all locations. Hexamethonium blocked EECR at 13 and 16 cm from CP but sensitized its activation at 1–7 cm from CP. EECR of the entire esophagus exists, which is directed in the orad direction only. EECR of striated muscle esophagus is mediated by vagus nerve and PEN and inhibited by mechanoreceptors of smooth muscle esophagus. EECR of smooth muscle esophagus is mediated by enteric nervous system and vagus nerve. Activation of EECR of the striated muscle esophagus is initially sensitized by HCl exposure, which may have a role in prevention of supraesophageal reflux.NEW & NOTEWORTHY An esophago-esophageal contractile reflex (EECR) exists, which is directed in the orad direction only. EECR of the proximal esophagus can appear similar to and be mistaken for secondary peristalsis. The EECR of the striated muscle is mediated by the vagus nerve and pharyngoesophageal nerve and inhibited by mechanoreceptor input from the smooth muscle esophagus. HCl perfusion initially sensitizes activation of the EECR of the striated muscle esophagus, which may participate in prevention of supraesophageal reflux.

Characterization and mechanisms of the pharyngoesophageal inhibitory reflex

1998 ◽  
Vol 275 (5) ◽  
pp. G1127-G1136 ◽  
Author(s):  
Ivan M. Lang ◽  
Bidyut K. Medda ◽  
Junlong Ren ◽  
Reza Shaker
Keyword(s):  
Mechanical Stimulation ◽  
Water Injection ◽  
Posterior Wall ◽  
Air Injection ◽  
Pharyngeal Mucosa ◽  
Primary Peristalsis ◽  
Slow Infusion ◽  
Secondary Peristalsis ◽  
Inhibitory Reflex ◽  
Stimulation Of

The objectives of this study were to identify and to characterize the pharyngoesophageal inhibitory reflex (PEIR) in an animal model. Thirty-one cats (2.4–5.0 kg) were anesthetized using α-chloralose (45 mg/kg ip), and esophageal peristalsis was recorded manometrically. Secondary peristalsis was activated by rapid air injection (8–20 ml) at midesophagus or slow infusion of water through the manometric catheters. Neither stimulus activated primary peristalsis. The PEIR was activated by rapid water injection or focal mechanical stimulation of the pharynx. Rapid air injection activated secondary peristalsis in 92% of the trials, and slow water infusion activated 1 secondary peristalsis every 3.2 min. Pharyngeal stimulation by 0.3, 0.5, 0.8, or 1.0 ml of water inhibited or blocked ongoing secondary peristalsis in 67, 82, 97, or 93% of trials, respectively. Mechanical stimulation of the posterior wall of the pharynx with 11–20 g pressure attenuated secondary peristalsis in 96% of the trials or blocked secondary peristalsis in 41% of the trials. Centripetal electrical stimulation at 30 Hz, 0.2 ms, 2 V for 4 s of the superior laryngeal (SLN) or glossopharyngeal (GPN) nerves blocked or inhibited secondary peristalsis in 100% of the trials. Bilateral transection of the GPN ( n = 8), but not the SLN ( n = 6), blocked the PEIR. Anesthetization of the pharyngeal mucosa using lidocaine (2%) blocked the PEIR ( n = 3). We concluded that 1) the PEIR exists in the cat, 2) mechanical stimulation of the pharynx more strongly activates the PEIR than water, 3) activation of either SLN or GPN afferents attenuates ongoing secondary peristalsis, 4) the receptors mediating the PEIR are located in the pharyngeal mucosa, and 5) both SLN and GPN contribute to the PEIR, but the GPN is the major afferent limb of this reflex.

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