Secondary oesophageal peristalsis in patients with non-obstructive dysphagia.

Abstract

Secondary peristalsis was investigated in 30 patients with non-obstructive dysphagia and 20 age matched controls. Oesophageal motility was recorded at 3 cm intervals along the oesophageal body. Primary peristalsis was tested with 5 ml water swallows. Secondary peristalsis was stimulated with 10 ml boluses of air and water injected in the midoesophagus and by distensions (5 seconds duration) with a 3 cm balloon at the same level. Primary peristalsis was normal in 19 of the 20 control subjects and in nine of the 30 patients with dysphagia; 11 patients had diffuse spasm and 10 had non-specific abnormalities of primary peristalsis. Secondary peristalsis was triggered significantly less frequently by air and water distension in dysphagia patients (median success rate of 10% for the air boluses and 0% for the water boluses) than in control subjects (50% and 30% respectively, p<0.005), and was abnormal in six of nine patients with normal primary peristalsis, nine of 11 patients with diffuse spasm and eight of 10 patients with non-specific motor abnormalities. The median frequency of balloon induced secondary peristalsis, however, was not significantly different in the two groups (0% controls, 40% nonobstructive dysphagia, p=0 22). For each stimulus, there were no significant differences in the response rate in the three subgroups of patients. The major pattern of failure of secondary peristalsis in response to the air and water boluses was the complete absence of any oesophageal response. The amplitude of complete secondary peristalsis triggered by the water boluses and the balloon was greater in the patients with dysphagia (p=003) than in normal subjects, while the amplitude of the secondary peristaltic responses triggered by the air boluses was similar in the two groups. Secondary peristaltic velocity was also similar in normal subjects and patients with nonobstructive dysphagia. Patients with non-obstructive dysphagia show a noticeable defect in the triggering of secondary peristalsis which may make an important contribution to the delayed oesophageal bolus transit and dysphagia seen in this condition.

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

“…Impaired distension-induced esophageal contractility and deficient acid clearance have been described in pa tients with gastroesophageal reflux [18,19] and an abnor mal distension response pattern has been noted in pa tients with functional dysphagia [20,21 ].…”

Oesophageal bolus transit and clearance by secondary peristalsis in normal individuals

“…Secondary peristalsis can be reliably triggered by intraoesophageal air or water infusion [3]. Although ample data are available in published works about the manometric characteristics and reproducibility of initiation of secondary peristalsis in health and a variety of disease states [3][4][5][6][7], there is a paucity of data on the efficiency of oesophageal bolus transport and clearance by secondary peristalsis in health or in disease.…”

Current perspectives on the diagnosis and treatment of functional esophageal disorders

“…Esophageal motility abnormalities (eg, simultaneous contractions and ineffective peristalsis) and impaired visceral sensitivity to chemical or mechanical stimuli have been suggested as underlying mechanisms [3]. Abnormal secondary peristalsis in the presence of normal primary peristalsis has been demonstrated in nine subjects with functional dysphagia [9]. In another study, the authors suggested that patients with nonobstructive dysphagia (including those with functional dysphagia) are more likely to demonstrate reduced perception thresholds to esophageal balloon distention than normal controls [10].…”