Background and Aims
Differences in contraction characteristics between primary and secondary peristalsis have only been scarcely studied. Recently new measures of contractile activity in the human esophagus were developed. The study aims were to use combined manometry and impedance planimetry [pressure-cross-sectional area (P-CSA)] recordings from healthy volunteers to examine esophageal peristalsis, and, furthermore, to investigate the effect of the motility enhancing drug erythromycin to study differential effects on the two types of contractions.
Sixteen healthy volunteers participated in the study [mean age 23 (range, 19–34) years, 6 females]. An esophageal probe with a bag for CSA measurement was positioned 10 cm above the lower esophageal sphincter. Bag volume was increased stepwise from 5 to 25 ml before and after intravenous infusion of 250 mg erythromycin. Swallow-evoked primary and distension-evoked secondary esophageal peristalsis were compared with regard to (1) pressure amplitude, (2) CSA amplitude, (3) preload tension (wall tension before an evoked contraction), (4) contractile tension, and (5) work outputs.
Primary peristalsis induced more efficient contractions as the contraction amplitudes, work output and contractile tension were higher compared to secondary peristalsis (P < 0.001). Erythromycin induced change in CSA during distension-evoked secondary peristalsis (CSA before 212.9 ± 26.8 vs. after 180.5 ± 23.3, P < 0.05). The sensitivity to esophageal distension increased with the distending volume both before and during erythromycin. The sensitivity was not changed by erythromycin (P = 0.6).
Esophageal primary peristaltic contractions were more forceful with longer duration, and higher work output compared to secondary peristalsis contractions. Erythromycin affected peristalsis only to a minor degree.
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Costa M, Brookes SJ, Hennig GW. Anatomy and physiology of the enteric nervous system. Gut. 2000;47:iv15–iv19.
Fleshler B, Hendrix TR, Kramer P, Imgelfinger FJ. The characteristics and similarity of primary and secondary peristalsis in the esophagus. J Clin Invest. 1959;38:110–116.
Paterson WG, Hynna-Liepert TT, Selucky M. Comparison of primary and secondary esophageal peristalsis in humans: effect of atropine. Am J Physiol. 1991;260:G52–G57.
Kahrilas PJ, Sifrim D. High-resolution manometry and impedance-pH/manometry: valuable tools in clinical and investigational esophagology. Gastroenterology. 2008;135:756–769.
Schoeman MN, Holloway RH. Stimulation and characteristics of secondary oesophageal peristalsis in normal subjects. Gut. 1994;35:152–158.
Gregersen H, Villadsen GE, Liao D. Mechanical characteristics of distension-evoked peristaltic contractions in the esophagus of systemic sclerosis patients. Dig Dis Sci. 2011;56:3559–3568.
Liao D, Villadsen GE, Gregersen H. Distension-evoked motility analysis in human esophagus. Neurogastroenterol Motil. 2013;25:407.
Drewes AM, Schipper KP, Dimcevski G, et al. Multimodal assessment of pain in the esophagus: a new experimental model. Am J Physiol Gastrointest Liver Physiol. 2002;283:G95–G103.
Paterson WG, Rattan S, Goyal RK. Esophageal responses to transient and sustained esophageal distension. Am J Physiol. 1988;255:G587–G595.
Winship DH, Zboralske FF. The esophageal propulsive force: esophageal response to acute obstruction. J Clin Invest. 1967;46:1391–1401.
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.
Guyton A, Hall J. Textbook of Medical Physiology. Philadelphia: W.B.Saunders Company; 2002.
Krarup AL, Liao D, Gregersen H, et al. Nonspecific motility disorders, irritable esophagus, and chest pain. Ann NY Acad Sci. 2013;1300:96–109.
Kao CH, Wang SJ, Pang DY. Effects of oral erythromycin on upper gastrointestinal motility in patients with non-insulin-dependent diabetes mellitus. Nucl Med Commun. 1995;16:790–793.
Chang CT, Shiau YC, Lin CC, Li TC, Lee CC, Kao CH. Improvement of esophageal and gastric motility after 2-week treatment of oral erythromycin in patients with non-insulin-dependent diabetes mellitus. J Diabetes Complicat. 2003;17:141–144.
Tzovaras G, Xynos E, Chrysos E, Mantides A, Vassilakis JS. The effect of intravenous erythromycin on esophageal motility in healthy subjects. Am J Surg. 1996;171:316–319.
Chen C-L. Relationships among afferent neural processing, peristalsis and bolus clearance in the human oesophagus: implications for symptom perception and dysphagia. 2008. Thesis/dissertation. http://www.unsworks.unsw.edu.au/primo_library/libweb/action/dlDisplay.do?vid=UNSWORKS&docId=unsworks_4472&fromSitemap=1&afterPDS=true. Accessed 20 Nov 2013.
Schoeman MN, Holloway RH. Secondary oesophageal peristalsis in patients with non-obstructive dysphagia. Gut. 1994;35:1523–1528.
Karen Elise Jensens Foundation is thanked for financial support.
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Liao, D., Krarup, A.L., Lundager, F.H. et al. Quantitative Differences Between Primary and Secondary Peristaltic Contractions of the Esophagus. Dig Dis Sci 59, 1810–1816 (2014). https://doi.org/10.1007/s10620-014-3070-1
- Human esophagus
- Pressure-cross sectional area
- Work output
- Primary peristalsis
- Secondary peristalsis