Primary and secondary esophageal contractions in patients with gastroesophageal reflux disease

Abstract

We studied the primary and secondary esophageal peristalsis in 36 patients with heartburn and acid regurgitation and in 14 asymptomatic volunteers. Primary peristalsis was elicited by ten swallows of a 5-mL bolus of water and secondary peristalsis was elicited by intra-esophageal infusion of 5, 10, and 15 mL water, 0.1 N hydrochloric acid and air. Esophageal contractions were measured by an 8-lumen manometric catheter assembly incorporating a 6-cm sleeve device. Contractions were registered at 3, 9, and 15 cm from the upper margin of the sleeve and the infusion was done through a side hole located at 12 cm. Twenty patients had normal endoscopic esophageal examination, 10 with normal (group I) and 10 with abnormal pH-metric examination (group II), and 16 had esophagitis (group III). The amplitude of contractions after swallows was lower (97.8 ± 10.0 mmHg) in the distal esophagus of group III patients than in controls (142.3 ± 14.0 mmHg). Patients of group III had fewer secondary contractions (water: 25% of infusion) than patients of the other groups and controls (67% of infusion). Patients of group III also had a lower amplitude of secondary peristalsis in the distal esophagus (water: 70.1 ± 9.6 mmHg) than controls (129.2 ± 18.2 mmHg). We conclude that patients with esophagitis have an impairment of primary and secondary peristalsis in the distal esophagus.

Gastroesophageal reflux disease and chronic cough: A possible mechanism elucidated by ambulatory pH‐impedance‐pressure monitoring

“…ineffective (61.8%-88.6%), low pressure amplitude in both the distal and proximal esophagus results in 38.5% IEM of primary peristalsis, and more synchronous contractions in secondary peristalsis result in IEM in patients with GERD-CC. Those findings are consistent with impairment of primary and secondary peristalsis leading to ineffective esophageal clearance and prolonged exposure to acid 43,44. Thus, we might extrapolate that low pan-esophageal pressure amplitude in primary peristalsis and synchronous contraction in secondary peri-No coughing was recorded in 16.1% of patients with GERD-CC.…”

Relevance of mild ineffective oesophageal motility (IOM) and potential pharmacological reversibility of severe IOM in patients with gastro‐oesophageal reflux disease

“…It is possible, however, that patients with severe IOM had impaired secondary peristalsis. 40 Our study showed an important overlap in values of acid exposure between patients with mild-andsevere IOM. Furthermore, the presence of hiatal hernia and male sex may significantly impact acid exposure in patients with mild IOM.…”

Manometric Subtypes of Ineffective Esophageal Motility

“…There are experimental studies that report reversibility of esophageal hypomotility after healing of inflammation. 36, 37, 38 Fornari and colleagues reported a transient reversibility of over 50% in 11 patients with severe IEM after adequate cholinergic stimulation of the esophagus. 34 However, other studies show that patients with chronic erosive GERD did not recover from esophageal dysmotility after pharmacological or surgical treatment of their reflux disease.…”