Digestive Diseases and Sciences

, Volume 58, Issue 7, pp 1948–1954 | Cite as

Influence of Intraluminal Acidification on Esophageal Secondary Peristalsis in Humans

Original Article



Secondary peristalsis contributes to clearance of retained refluxate or material from the esophagus.


The goal of our study was to investigate the effects of hydrochloric acid (HCl) on physiological characteristics of esophageal secondary peristalsis in healthy adults.


After recording esophageal motility baseline for primary peristalsis, secondary peristalsis was stimulated with slow and rapid air injections in the mid-esophageal in 16 healthy subjects. Normal saline and HCl (0.1 N) were separately infused into the esophagus to test whether they had effects on secondary peristalsis.


After infusion of HCl, the threshold volume to generate secondary peristalsis was significantly decreased during rapid and slow air infusions (both P < 0.05). The frequency of secondary peristalsis was increased after HCl infusion (90 % [72.5–100 %] versus 85 % [72.5–90 %], P = 0.002). Infusion of HCl significantly increased pressure wave amplitude during rapid and slow air infusions (both P < 0.05). Infusion of saline did not affect any parameters of secondary peristalsis. The occurrence of heartburn was generated in 7 of 16 subjects after infusion of HCl with an increase in visual analogue scale score (12.5).


Our data show that acute esophageal acid infusion enhances sensitivity of distension-induced secondary peristalsis and enhances secondary peristaltic activity. The study supports the evidence of the presence of acid-sensitive afferents in the modulation of distension-induced secondary peristalsis in humans.


Secondary peristalsis Hydrochloric acid Esophageal motility 


  1. 1.
    Helm JF, Dodds WJ, Pelc LR, Palmer DW, Hogan WJ, Teeter BC. Effect of esophageal emptying and saliva on clearance of acid from the esophagus. N Engl J Med. 1984;310:284–288.PubMedCrossRefGoogle Scholar
  2. 2.
    Pandolfino JE, Shi G, Zhang Q, Kahrilas PJ. Absence of a deglutitive inhibition equivalent with secondary peristalsis. Am J Physiol Gastrointest Liver Physiol. 2005;288:G671–G676.PubMedCrossRefGoogle Scholar
  3. 3.
    Schoeman MN, Holloway RH. Stimulation and characteristics of secondary oesophageal peristalsis in normal subjects. Gut. 1994;35:152–158.PubMedCrossRefGoogle Scholar
  4. 4.
    Schoeman MN, Holloway RH. Secondary oesophageal peristalsis in patients with non-obstructive dysphagia. Gut. 1994;35:1523–1528.PubMedCrossRefGoogle Scholar
  5. 5.
    Schoeman MN, Holloway RH. Integrity and characteristics of secondary oesophageal peristalsis in patients with gastro-oesophageal reflux disease. Gut. 1995;36:499–504.PubMedCrossRefGoogle Scholar
  6. 6.
    Sifrim D, Janssens J. Secondary peristaltic contractions, like primary peristalsis, are preceded by inhibition in the human esophageal body. Digestion. 1996;57:73–78.PubMedCrossRefGoogle Scholar
  7. 7.
    Hwang K. Mechanism of transportation of the content of the esophagus. J Appl Physiol. 1954;6:781–796.PubMedGoogle Scholar
  8. 8.
    Paterson WG. Neuromuscular mechanisms of esophageal responses at and proximal to a distending balloon. Am J Physiol. 1991;260:G148–G155.PubMedGoogle Scholar
  9. 9.
    Kravitz JJ, Snape WJ Jr, Cohen S. Effect of thoracic vagotomy and vagal stimulation on esophageal function. Am J Physiol. 1978;234:E359–E364.PubMedGoogle Scholar
  10. 10.
    Lang IM, Medda BK, Shaker R. Mechanisms of reflexes induced by esophageal distension. Am J Physiol Gastrointest Liver Physiol. 2001;281:G1246–G1263.PubMedGoogle Scholar
  11. 11.
    Bontempo I, Piretta L, Corazziari E, Michetti F, Anzini F, Torsoli A. Effects of intraluminal acidification on oesophageal motor activity. Gut. 1994;35:884–890.PubMedCrossRefGoogle Scholar
  12. 12.
    Kjellen G, Tibbling L. Oesophageal motility during acid-provoked heartburn and chest pain. Scand J Gastroenterol. 1985;20:937–940.PubMedCrossRefGoogle Scholar
  13. 13.
    Richter JE, Johns DN, Wu WC, Castell DO. Are esophageal motility abnormalities produced during the intraesophageal acid perfusion test? JAMA. 1985;253:1914–1917.PubMedCrossRefGoogle Scholar
  14. 14.
    Thompson DG, Andreollo NA, McIntyre AS, Earlam RJ. Studies of the oesophageal clearance responses to intraluminal acid. Gut. 1988;29:881–885.PubMedCrossRefGoogle Scholar
  15. 15.
    Kusano M, Hogan WJ, Lang IM, Bonnevier JL, Massey BT, Shaker R. Initiation of esophageal secondary peristalsis by slow fluid infusion in the opossum: effect of hydrochloric acid. Am J Physiol. 1996;270:G927–G931.PubMedGoogle Scholar
  16. 16.
    Chen CL, Liu TT, Yi CH. Effects of lidocaine on esophageal secondary peristalsis in humans. Neurogastroenterol Motil. 2010;22:606–610.PubMedCrossRefGoogle Scholar
  17. 17.
    Chen CL, Liu TT, Yi CH, Orr WC. Effects of capsaicin-containing red pepper sauce suspension on esophageal secondary peristalsis in humans. Neurogastroenterol Motil. 2010;22:1177–1182, e312–313.Google Scholar
  18. 18.
    Chen CL, Szczesniak MM, Cook IJ. Oesophageal bolus transit and clearance by secondary peristalsis in normal individuals. Eur J Gastroenterol Hepatol. 2008;20:1129–1135.PubMedCrossRefGoogle Scholar
  19. 19.
    Chen CL, Orr WC. Autonomic responses to heartburn induced by esophageal acid infusion. J Gastroenterol Hepatol. 2004;19:922–926.PubMedCrossRefGoogle Scholar
  20. 20.
    Chen CL, Liu TT, Yi CH. Control of esophageal distension-induced secondary peristalsis by the GABA(B) agonist baclofen in humans. Neurogastroenterol Motil. 2011;23:612–e250.PubMedGoogle Scholar
  21. 21.
    Chen CL, Liu TT, Yi CH, Orr WC. Effects of mosapride on esophageal secondary peristalsis in humans. Neurogastroenterol Motil. 2011;23:606–e249.PubMedGoogle Scholar
  22. 22.
    Ren J, Shaker R, Kusano M, et al. Effect of aging on the secondary esophageal peristalsis: presbyesophagus revisited. Am J Physiol. 1995;268:G772–G779.PubMedGoogle Scholar
  23. 23.
    Corazziari E, Pozzessere C, Dani S, Anzini F, Torsoli A. Intraluminal pH esophageal motility. Gastroenterology. 1978;75:275–277.PubMedGoogle Scholar
  24. 24.
    Madsen T, Wallin L, Boesby S, Larsen VH. Oesophageal peristalsis in normal subjects. Influence of pH and volume during imitated gastro-oesophageal reflux. Scand J Gastroenterol. 1983;18:513–518.PubMedCrossRefGoogle Scholar
  25. 25.
    Clerc N, Mei N. Vagal mechanoreceptors located in the lower oesophageal sphincter of the cat. J Physiol. 1983;336:487–498.PubMedGoogle Scholar
  26. 26.
    Page AJ, Blackshaw LA. An in vitro study of the properties of vagal afferent fibres innervating the ferret oesophagus and stomach. J Physiol. 1998;512(Pt 3):907–916.PubMedCrossRefGoogle Scholar
  27. 27.
    Satchell PM. Canine oesophageal mechanoreceptors. J Physiol. 1984;346:287–300.PubMedGoogle Scholar
  28. 28.
    Bardan E, Xie P, Aslam M, Kern M, Shaker R. Disruption of primary and secondary esophageal peristalsis by afferent stimulation. Am J Physiol Gastrointest Liver Physiol. 2000;279:G255–G261.PubMedGoogle Scholar
  29. 29.
    Siegel CI, Hendrix TR. Esophageal motor abnormalities induced by acid perfusion in patients with heartburn. J Clin Invest. 1963;42:686–695.PubMedCrossRefGoogle Scholar
  30. 30.
    Burns TW, Venturatos SG. Esophageal motor function and response to acid perfusion in patients with symptomatic reflux esophagitis. Dig Dis Sci. 1985;30:529–535.PubMedCrossRefGoogle Scholar
  31. 31.
    Bhalla V, Liu J, Puckett JL, Mittal RK. Symptom hypersensitivity to acid infusion is associated with hypersensitivity of esophageal contractility. Am J Physiol Gastrointest Liver Physiol. 2004;287:G65–G71.PubMedCrossRefGoogle Scholar
  32. 32.
    Bass BL, Trad KS, Harmon JW, Hakki FZ. Capsaicin-sensitive nerves mediate esophageal mucosal protection. Surgery. 1991;110:419–425 (discussion 425–426).PubMedGoogle Scholar
  33. 33.
    Holzer P. The pharmacological challenge to tame the transient receptor potential vanilloid-1 (TRPV1) nocisensor. Br J Pharmacol. 2008;155:1145–1162.PubMedCrossRefGoogle Scholar
  34. 34.
    Page AJ, Brierley SM, Martin CM, et al. Different contributions of ASIC channels 1a, 2, and 3 in gastrointestinal mechanosensory function. Gut. 2005;54:1408–1415.PubMedCrossRefGoogle Scholar
  35. 35.
    Orlando RC. Review article: oesophageal mucosal resistance. Aliment Pharmacol Ther. 1998;12:191–197.PubMedCrossRefGoogle Scholar
  36. 36.
    Tobey NA, Carson JL, Alkiek RA, Orlando RC. Dilated intercellular spaces: a morphological feature of acid reflux–damaged human esophageal epithelium. Gastroenterology. 1996;111:1200–1205.PubMedCrossRefGoogle Scholar
  37. 37.
    Sarkar S, Aziz Q, Woolf CJ, Hobson AR, Thompson DG. Contribution of central sensitisation to the development of non-cardiac chest pain. Lancet. 2000;356:1154–1159.PubMedCrossRefGoogle Scholar
  38. 38.
    Sarkar S, Hobson AR, Furlong PL, Woolf CJ, Thompson DG, Aziz Q. Central neural mechanisms mediating human visceral hypersensitivity. Am J Physiol Gastrointest Liver Physiol. 2001;281:G1196–G1202.PubMedGoogle Scholar
  39. 39.
    Park H, Conklin JL. Neuromuscular control of esophageal peristalsis. Curr Gastroenterol Rep. 1999;1:186–197.PubMedCrossRefGoogle Scholar
  40. 40.
    Dooley CP, Schlossmacher B, Valenzuela JE. Effects of alterations in bolus viscosity on esophageal peristalsis in humans. Am J Physiol. 1988;254:G8–G11.PubMedGoogle Scholar
  41. 41.
    Janssens J, Valembois P, Hellemans J, Vantrappen G, Pelemans W. Studies on the necessity of a bolus for the progression of secondary peristalsis in the canine esophagus. Gastroenterology. 1974;67:245–251.PubMedGoogle Scholar
  42. 42.
    Janssens J, Valembois P, Vantrappen G, Hellemans J, Pelemans W. Is the primary peristaltic contraction of the canine esophagus bolus-dependent? Gastroenterology. 1973;65:750–756.PubMedGoogle Scholar
  43. 43.
    Kindt S, Vos R, Blondeau K, Tack J. Influence of intra-oesophageal capsaicin instillation on heartburn induction and oesophageal sensitivity in man. Neurogastroenterol Motil. 2009;21:1032–e82.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of MedicineBuddhist Tzu Chi General Hospital and Tzu Chi UniversityHualienTaiwan

Personalised recommendations