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Digestive Diseases and Sciences

, Volume 32, Issue 6, pp 583–592 | Cite as

Esophageal manometry in 95 healthy adult volunteers

Variability of pressures with age and frequency of “abnormal” contractions
  • Joel E. Richter
  • Wallace C. Wu
  • Doree N. Johns
  • John N. Blackwell
  • Joseph L. NelsonIII
  • June A. Castell
  • Donald O. Castell
Original Articles

Abstract

Although esophageal manometry is widely used in clinical practice, the normal range of esophageal contraction parameters is poorly defined. Therefore, 95 healthy volunteers (mean age: 43 years; range 22–79 years) were studied with a low-compliance infusion system and 4.5-mm-diameter catheter. All subjects were given 10 wet swallows (5 cc H2O) and 38 subjects also were given 10 dry swallows. Results: Amplitude, but not duration, was greater (P<0.05) after wet compared to dry swallows. Both distal mean contractile amplitude and duration of wet swallows significantly increased with age and peaked in the fifties. Double-peaked waves frequently occurred after both wet (11.3%) and dry (18.1%) swallows, but triple-peaked waves were rare (<1%). Nonperistaltic contractions were more common (P<0.001) after dry compared to wet swallows (18.1% vs 4.1%). This difference resulted from frequent simultaneous contractions after dry swallows (12.6% vs 0.4%). Conclusions: (1) Distal esophageal contractile amplitude and duration after wet swallows increases with age. (2) Triple-peaked waves and wet-swallow-induced simultaneous contractions should suggest an esophageal motility disorder. Double-peaked waves are a common variant of normal. (3) Dry swallows have little use in the current evaluation of esophageal peristalsis.

Key Words

esophageal peristalsis esophageal motility disorders diffuse esophageal spasm high-amplitude peristalsis 

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References

  1. 1.
    Arndorfer R: Improved infusion system for intraluminal esophageal manometrics. Gastroenterology 73:23–27, 1977Google Scholar
  2. 2.
    Nagler R, Spiro HM: Serial esophageal motility studies in asymptomatic young subjects. Gastroenterology 41:371–379, 1961Google Scholar
  3. 3.
    Hellemans J, Vantrappen G, Janssens J, Pelmans W, Valembois D: Function of the Esophagus, 1st ed. Brussels, Odense University Press 1973, pp 38–44Google Scholar
  4. 4.
    Dodds WJ, Hogan WJ, Reid DP, Stewart EI, Arndorfer RC: A comparison between primary esophageal peristalsis following wet and dry swallows. J Appl Physiol 354:851–857, 1973Google Scholar
  5. 5.
    Hollis JB, Castell DO: Effect of dry swallows and wet swallows of different volumes on esophageal peristalsis. J Appl Physiol 38:1161–1164, 1975Google Scholar
  6. 6.
    Dodds WJ, Hogan WJ, Stef JJ, Miller WN, Lydon SB, Arndorfer RC: A rapid pull-through technique for measuring lower esophageal sphincter pressure. Gastroenterology 68:437–442, 1975Google Scholar
  7. 7.
    Clouse RE, Staiano A: Contraction abnormalities of the esophageal body in patients referred for manometry: A new approach to manometric classification. Dig Dis Sci 28:784–791, 1983Google Scholar
  8. 8.
    Richter JE, Blackwell JN, Wu WC, Cowan RJ, Johns DN, Castell DO: Assessment of liquid bolus transit by simultaneous radionuclide transit and esophageal manometry. Gastroenterology 24:1284A, 1983Google Scholar
  9. 9.
    Ingelfinger FJ: Esophageal motility. Physiol Rev 38:533–584, 1958Google Scholar
  10. 10.
    Kaye MD, Wexler RM: Alteration of esophageal peristalsis by body position. Dig Dis Sci 26:897–901, 1981Google Scholar
  11. 11.
    Hollis JB, Castell DO: Esophageal function in elderly men. A new look at “presbyesophagus”. Ann Intern Med 80:371–374, 1974Google Scholar
  12. 12.
    Benjamin SB, Gerhardt DC, Castell DO: High-amplitude peristaltic esophageal contractions associated with chest pain and/or dysphagia. Gastroenterology 77:478–483, 1979Google Scholar
  13. 13.
    Nelson JL, Wu WC, Richter JE, Blackwell NJ, Johns DN, Castell DO: What is normal esophageal motility? Gastroenterology 84:1285A, 1983Google Scholar
  14. 14.
    Richter JE, Sinar D, Cordova C, Castell DO: Verapamil—a potent inhibition of esophageal contractions in the baboon. Gastroenterology 82:882–886, 1982Google Scholar
  15. 15.
    Loo FD, Dodds WJ, Soergel KH, Arndorfer RC, Helm JF, Hogan WF: Multipeaked esophageal peristaltic pressure waves in patients with diabetic neuropathy. Gastroenterology 88:485–491, 1985Google Scholar
  16. 16.
    Davies HA, Kaye MD, Rhoades J, Dart AM, Henderson AH: Diagnosis of oesophageal spasm by ergometrine provocation. Gut 23:89–97, 1982Google Scholar
  17. 17.
    Richter JE, Castell DO: Diffuse esophageal spasm: A reappraisal. Ann Intern Med 100:242–245, 1984Google Scholar
  18. 18.
    Gillies M, Nick R, Skyring A: Clinical, manometric, and pathological studies in diffuse oesophageal spasm. Br Med J 2:527–530, 1967Google Scholar
  19. 19.
    Welch RW, Drake ST: Normal lower esophageal sphincter: A comparison of rapid vs slow pull-through techniques. Gastroenterology 78:1446–1451, 1980Google Scholar
  20. 20.
    Dent J, Dodds WJ, Friedman RH, Sekiguchi T, Hogan WJ, Arndorfer RC, Petrie DJ: Mechanism of gastroesophageal reflux in recumbent asymptomatic human subjects. J Clin Invest 65:256–267, 1980Google Scholar
  21. 21.
    Boyle JT, Altschuler SM, Nixon TE, Tuchman DN, Pack AI, Cohn S: Role of the diaphragm in the genesic of lower esophageal sphincter pressure in the cat. Gastroenterology 88:723–730, 1985Google Scholar
  22. 22.
    Csendes A, Guiraldes E, Bancalari A, Braghetto I, Ayloa M: Relation of gastroesophageal sphincter pressure and esophageal contractile waves to age in man. Scand J Gastroenterol 13:443–447, 1978Google Scholar
  23. 23.
    Lydon SB, Dodds WJ, Hogan WJ, Arndorfer RC: The effect of manometric assembly diameter on intraluminal esophageal pressure recording. Dig Dis Sci 20:968–970, 1975Google Scholar
  24. 24.
    Petersen JM, Traube M, Magyar L, McCallum RW: Segmental esophageal aperistalsis as a cause of chest pain and/or dysphagia. Gastroenterology 88:1538A, 1985Google Scholar
  25. 25.
    Dodds WJ, Steff JJ, Hogan WJ: Factors determining pressure measurement accuracy by intraluminal esophageal manometry. Gastroenterology 70:117–123, 1976Google Scholar

Copyright information

© Plenum Publishing Corporation 1987

Authors and Affiliations

  • Joel E. Richter
    • 1
  • Wallace C. Wu
    • 1
  • Doree N. Johns
    • 1
  • John N. Blackwell
    • 1
  • Joseph L. NelsonIII
    • 1
  • June A. Castell
    • 1
  • Donald O. Castell
    • 1
  1. 1.Gastroenterology Section, Department of MedicineBowman Gray School of Medicine of Wake Forest UniversityWinston-Salem

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