Human esophageal response to rapid swallowing: muscle refractory period or neural inhibition?

Meyer, George W.; Gerhardt, Donald C.; Do, Castell

doi:10.1152/ajpgi.1981.241.2.g129

Cited by 71 publications

(69 citation statements)

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“…This observation indicates that each new deglutition may inhibit the activity of the previous swal low. This phenomenon has been called 'deglutitive inhibi tion' [22][23][24][25], In addition to the effect of a second swallow on a previous swallow, the occurrence of a previous swal low can dramatically alter the nature of a subsequent swallow, decreasing its amplitude and at times rendering it nonperistaltic. This effect has been called 'refractori ness'.…”

Section: Discussionmentioning

confidence: 99%

Secondary Peristaltic Contractions, like Primary Peristalsis, Are Preceded by Inhibition in the Human Esophageal Body

Sifrim¹,

Janssens²

1996

Digestion

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Swallow-induced esophageal peristalsis is preceded by a wave of inhibition in the esophageal body. The aim of this study was to determine whether a similar wave of inhibition precedes secondary peristalsis. Primary and secondary peristalsis were studied in 6 healthy subjects. Inhibition was visualized as relaxation of an artificial high-pressure zone which was created in the esophageal body by the inflation of a small intraesophageal balloon. Secondary peristaltic contractions induced by injection of 10 ml of air in the proximal esophagus or secondary peristaltic contractions spontaneously occurring after repeated swallowing were preceded by inhibition similar to that observed in primary peristalsis (96.4 ± 2.8%, 93.2 ± 4.2% and 91.5 ± 3.3%) respectively. It is concluded that physiologically triggered secondary peristaltic contractions are preceded by inhibition in the esophageal body.

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Section: Discussionmentioning

confidence: 99%

Secondary Peristaltic Contractions, like Primary Peristalsis, Are Preceded by Inhibition in the Human Esophageal Body

Sifrim¹,

Janssens²

1996

Digestion

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“…Repetitive swallowing at short intervals, as occurs during drinking of liquids, produces an esophageal response characterized by quiescence until the last of the swallows, which is then followed by an esophageal contraction (6)(7)(8). Meyer et al (7) have also shown that two or more swallows taken in rapid succession may markedly influence the response to the preceding swallows.…”

Section: Introductionmentioning

confidence: 99%

Influence of successive vagal stimulations on contractions in esophageal smooth muscle of opossum.

Gidda¹,

Goyal²

1983

J. Clin. Invest.

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A B S T R A C T Studies were performed in anesthetized opossums to investigate the influence of successive vagal stimuli on esophageal contractions. Mechanical activity was recorded manometrically 5 cm above the lower esophageal sphincter. Contractions in the esophagus were evoked by electrical stimuli of 2.5 mA, and 1-ms pulse duration applied to the cervical vagi, at various train durations and frequencies. Paired or multiple stimuli of 1-s train length were also tested at different interstimulus intervals (ISI). Paired stimuli at an ISI of <3 s and at a frequency of <10 Hz showed refractoriness, i.e., the contractions to the first stimulus inhibited the contraction to the second stimulus. A frequency of 50 Hz showed initial inhibition, i.e., the second stimulus inhibited the contraction to the first stimulus. Repetitive stimuli applied at a rate of 8/min (ISI 6.5 s) evoked contractions to each stimulus. At 15/ min, every second or third contraction was inhibited. With stimuli applied at 30/min, contractions occurred only in response to the first and/or the last stimulus; depending upon the frequency of vagal stimulation. The intervening stimuli did not evoke any contractions. A long train stimulus produced an initial, a terminal, or both contractions depending on the stimulation value. These studies show that (a) vagal efferent stimulation causes initial inhibition and refractoriness in the esophageal smooth muscle; (b) the degree of initial inhibition increases with increasing frequency of stimulation; (c) the occurrence of contractions only at the onset and the end of a long train stimulus may be due to the influence of initial inhibition and refractoriness.

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“…It thereby inhibits contraction in the esophageal body, and relaxes the LES [12]. Under physiological circumstances, the last swallow is often followed by a vigorous peristaltic contraction and a post-swallow LES after-contraction [31]. Both maneuvers generally test the overall integrity of the esophageal neuromuscular control, because a normal response requires intact inhibitory and excitatory central and peripheral neural pathways along with sufficient muscle reserve to produce a vigorous peristaltic contraction with or after the final swallow.…”

Section: Provocation Testsmentioning

confidence: 99%

What Is the Impact of High-Resolution Manometry in the Functional Diagnostic Workup of Gastroesophageal Reflux Disease

Keller¹

2018

Visc Med

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International guidelines agree that high-resolution esophageal manometry (HRM) is an integral part of the diagnostic evaluation of patients with refractory reflux symptoms and should be performed before antireflux surgery. Its most important goal is to explore differential diagnoses, in particular major esophageal motility disturbances, that may be responsible for symptoms. HRM additionally provides insights into all relevant pathomechanisms of gastroesophageal reflux disease (GERD): It can reveal important information on the morphology and function of the esophagogastric junction (EGJ), the presence of a hiatus hernia, transient lower esophageal sphincter relaxations, and dysmotility of the esophageal body. To obtain this information, a 3-step hierarchical system has been proposed for the algorithmic characterization of esophageal motor function. The first step is to investigate the morphology and contractility of the EGJ, the second to monitor esophageal body motor patterns in response to water swallows, and the third to determine the contraction reserve in patients with abnormal esophageal motor function using provocation tests. Observations made with HRM can not only explain the cause of symptoms in GERD patients but may also have the potential to direct specific treatment.

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Human esophageal response to rapid swallowing: muscle refractory period or neural inhibition?

Cited by 71 publications

References 0 publications

Secondary Peristaltic Contractions, like Primary Peristalsis, Are Preceded by Inhibition in the Human Esophageal Body

Secondary Peristaltic Contractions, like Primary Peristalsis, Are Preceded by Inhibition in the Human Esophageal Body

Influence of successive vagal stimulations on contractions in esophageal smooth muscle of opossum.

What Is the Impact of High-Resolution Manometry in the Functional Diagnostic Workup of Gastroesophageal Reflux Disease

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