Altered oesophageal mechanosensitivity of secondary peristalsis as a pathophysiological marker in patients with globus sensation

Abstract

Objective: Secondary peristalsis is important for clearance of retained food bolus and refluxate from the oesophagus. We aimed to investigate whether patients with globus sensation have altered physiological characteristics of secondary peristalsis.Design: Prospective case-controlled study Setting: Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.Participants: Seventeen globus patients and 18 healthy controls. Main outcome measures:After a baseline recording of primary peristalsis, secondary peristalsis was stimulated with slow and rapid mid-oesophageal injections of air. Distension thresholds and peristaltic activities of secondary peristalsis were analysed and compared between the patients and healthy controls. Results:The threshold volume for generating secondary peristalsis during slow air distension did not differ between the patient and control groups (P = .55). The threshold volume for generating secondary peristalsis during rapid air distension was significantly greater in patients with globus than healthy controls (7.0 AE 0.9 vs 5.0 AE 0.3 mL, P = .04). Secondary peristalsis was triggered less frequently in globus patients as compared with healthy control after rapid air distension (40% [30%-65%] vs 60% [60%-83%], P = .001). There was no difference in any of peristaltic parameters for primary and secondary peristalsis between the groups.Conclusions: Our work identifies functional defects of oesophageal secondary peristalsis in patients with globus sensation and such defects are characterised with defective triggering of secondary peristalsis during rapid air distension. Whether current findings have therapeutic implication in the management of patients with globus sensation warrants further investigation.

Esophageal Motor Dysfunctions in Gastroesophageal Reflux Disease and Therapeutic Perspectives

“…Bolus-induced peristalsis can be initiated by intrinsic neural programs independent of vagal activity, but is influenced by vagal activity. 36 Studies evaluating secondary peristalsis often involve injecting gas or liquid, first slowly then quickly, into the esophagus. The amount of gas or liquid inducing secondary peristalsis at different speeds is recorded separately, and the effectiveness of the secondary peristaltic response and related pressure parameters are identified.…”

Globus Pharyngeus: Etiology, Diagnostics and Treatment

“…31 Özofageal manometre kullanılarak yapılan bir çalışmada, globus hastalarında başta özofageal motilite bozukluğu olmakla beraber, %67'sinde özofagus anomalileri gözlenirken, prospektif vakakontrol çalışması olarak yapılan başka bir çalışmada ise özofagusun sekonder peristaltik hareketlerinde fonksiyonel defektler saptanmıştır. 11,32 Son yıllarda daha objektif bir yöntem olan YÇM'ler ile çeşitli çalışmalar yapılmış ve globus hastalarının yaklaşık yarısında özofageal motilite bozukluğu olduğu gözlenmiştir. 29 37…”