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


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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  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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