Swallow induces a peristaltic wave of distension that marches in front of the peristaltic wave of contraction

Abrahão, Luiz; Bhargava, Valmik; Babaei, Arash; Ho, Andrew P.; Mittal, Ravinder K.

doi:10.1111/j.1365-2982.2010.01624.x

Cited by 40 publications

(35 citation statements)

References 18 publications

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“…Furthermore, detection of bolus head on fluoroscopic images is subjective and may not allow precise determination of the arrival time on to impedance electrodes. In an earlier study, we found that single plane fluoroscopy does not detect changes in the esophageal CSA/distension accurately during peristalsis (11). …”

Section: Discussionmentioning

confidence: 95%

“…Since esophageal distension may be an important marker of the inhibition phase of the peristaltic reflex (11), simultaneous HRM and impedance measurement can provide information on contraction and relaxation phases of the esophageal peristaltic reflex. Furthermore, it may allow one to investigate if reduced distensibility of the esophagus during bolus transport plays an important role in the genesis of esophageal dysphagia.…”

Section: Discussionmentioning

confidence: 99%

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Esophageal distension during bolus transport: can it be detected by intraluminal impedance recordings?

Kim

Mittal

Patel

et al. 2014

Neurogastroenterology Motil

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Introduction Esophageal multiple intraluminal impedance (MII) measurement has been in used to detect gastroesophageal reflux and bolus transport. It is not clear if MII can detect changes in luminal cross sectional area (CSA) during bolus transport. Aims Intraluminal ultrasound (US) images, MII and high resolution manometry (HRM) were recorded simultaneously to determine temporal relationship between CSA and impedance during esophageal bolus transport and to define the relationship between peak distension and nadir impedance. Methods Studies were conducted in five healthy subjects. MII, HRM and US images were recorded 6 cm above LES. Esophageal distensions were studied during swallows and injections of 0.5 N saline bolus into the esophagus. Results Temporal change in esophageal CSA correlates with changes in impedance (r value: mean ± SD = −0.80 ± 0.08, range: −0.94 to −0.66). Drop in impedance during distension occurs as a two step process; initial large drop associated with onset of CSA increase, followed by a small drop during which majority of the CSA increase occurs. Peak CSA and nadir impedance occur within 1 s of each other. Increase in swallow and injection volumes increased the CSA, had no effect on large drop but increased the small drop amplitude. We observed a significant correlation between peak CSA and nadir impedance (r = − 0.90, p<0.001) and a better correlation between peak CSA and inverse impedance (r = 0.94, p<0.001). Conclusion Further studies are needed to confirm that intraluminal impedance recordings may be used to measure luminal CSA during esophageal bolus transport.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Esophageal distension during bolus transport: can it be detected by intraluminal impedance recordings?

Kim

Mittal

Patel

et al. 2014

Neurogastroenterology Motil

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“…In relation to the existence of such mechanisms, we also note the descending oesophageal peristaltic reflex in the opossum described by Paterson and Indrakrishnan 20 and the intrinsic wave of descending inhibition that precedes contraction of the distal oesophagus, recently described in human subjects by Abrahao and colleagues. 21 An interesting new finding in this study was the relationship between altered pressure-flow metrics and bolus perception. Perception of bolus passage was reported by half of the subjects and this was almost always in relation to solids.…”

Section: Discussionmentioning

confidence: 96%

Oesophageal pressure‐flow metrics in relation to bolus volume, bolus consistency, and bolus perception

et al. 2013

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“…A mechanical pull in the axial direction induces activation of inhibitory motor neurons located in the myenteric plexus, which releases nitric oxide (NO) to induce LES relaxation. Along the same lines, it is likely that elongation of the esophageal segment, distal to the site of contraction, induces active relaxation or descending relaxation18 of the esophagus distal to the contracted segment which is crucial for efficient bolus transport. Relaxation of the esophagus and LES distal to the contracted segment allows contracted and peristaltic segment to propel bolus in the caudal direction against minimal resistance in the relaxed segment (Fig.…”

Section: Patterns Of Longitudinal Muscle Contraction In Health and Itmentioning

confidence: 99%

Longitudinal Muscle Dysfunction in Achalasia Esophagus and Its Relevance

Mittal¹,

Hong²,

Bhargava³

2013

J Neurogastroenterol Motil

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Muscularis propria of the esophagus is organized into circular and longitudinal muscle layers. Goal of this review is to summarize the role of longitudinal muscle in physiology and pathophysiology of esophageal sensory and motor function. Simultaneous manometry and ultrasound imaging that measure circular and longitudinal muscle contraction respectively reveal that during peristalsis 2 layers of the esophagus contract in perfect synchrony. On the other hand, during transient relaxation of the lower esophageal sphincter (LES), longitudinal muscle contracts independently of circular muscle. Recent studies provide novel insights, i.e., longitudinal muscle contraction of the esophagus induces LES relaxation and possibly descending relaxation of the esophagus. In achalasia esophagus and other motility disorders there is discoordination between the 2 muscle layers. Longitudinal muscle contraction patterns are different in the recently described three types of achalasia identified by high-resolution manometry. Robust contraction of the longitudinal muscle in type II achalasia causes pan-esophageal pressurization and is the mechanism of whatever little esophageal emptying that take place in the absence of peristalsis and impaired LES relaxation. It may be that preserved longitudinal muscle contraction is also the reason for superior outcome to medical/surgical therapy in type II achalasia esophagus. Prolonged contractions of longitudinal muscles of the esophagus is a possible mechanism of heartburn and "angina like" pain seen in esophageal motility disorders and possibly achalasia esophagus. Novel techniques to record longitudinal muscle contraction are on the horizon. Neuro-pharmacologic control of circular and longitudinal muscles is different, which provides an important opportunity for the development of novel pharmacological therapies to treat sensory and motor disorders of the esophagus.

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Swallow induces a peristaltic wave of distension that marches in front of the peristaltic wave of contraction

Abstract: Distension and contraction waves are tightly coupled to each other and both traverse in a peristaltic fashion.

Cited by 40 publications

References 18 publications

Esophageal distension during bolus transport: can it be detected by intraluminal impedance recordings?

Esophageal distension during bolus transport: can it be detected by intraluminal impedance recordings?

Oesophageal pressure‐flow metrics in relation to bolus volume, bolus consistency, and bolus perception

Longitudinal Muscle Dysfunction in Achalasia Esophagus and Its Relevance

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