Motor responses of the oesophagus to intraluminal distension in normal subjects and patients with oesophageal clearance disorders.

Abstract

SUMMARY Oesophageal motor responses to intraluminal distension were studied manometrically in 16 healthy volunteers and in nine patients with disordered swallowing, who had prolonged oesophageal clearance without structural abnormality. In the normal subjects distension was associated with an increased number of secondary contractions above the balloon, decrease of all contractile activity below the balloon and was accompanied by an aborally propulsive force which occurred independently of the perception of discomfort. Cholinergic blockade abolished the proximal distension induced contractile response, but did not affect primary peristalsis. Despite normal sensory thresholds, proximal excitatory responses to distension were absent in six and distal inhibition was absent in seven patients. These results show that the normal human oesophagus responds to distension with a proximal enhancement of propulsive motor activity, mediated through a cholinergic pathway. This may be defective in some patients with disordered oesophageal transit. Investigation of the motor responses to intraluminal distension may thus be a useful adjunct to standard manometry for studying patients with suspected oesophageal clearance dysfunction and might allow identification of disordered enteric nervous control.

Electroesophagogram: An Experimental Study on the Electromechanical Activity of the Esophagus

“…Upon distension by a balloon which simu lates food bolus, these esophageal contractions increase in frequency and amplitude proximally, but decrease distal ly to the balloon and are most likely responsible for the transmission of the bolus down the esophagus. Our results are in accord with those of other investigators who studied the motor responses of the human esophagus to distension [3,[24][25][26]. These authors found that esophageal disten sion induces an increased motor activity above and a reduced motor activity below the distension.…”

Secondary Peristaltic Contractions, like Primary Peristalsis, Are Preceded by Inhibition in the Human Esophageal Body

“…Impaired distension-induced esophageal contractility and deficient acid clearance have been described in pa tients with gastroesophageal reflux [18,19] and an abnor mal distension response pattern has been noted in pa tients with functional dysphagia [20,21 ].…”

Identification of the biomechanical factors associated with the perception of distension in the human esophagus

“…The use of volume, rather than cross-sectional area (CSA), however, introduces a number of problems. In particular, compliance of the esophagus varies along its length, being lower in the distal esophagus with a higher pressure being generated for a given degree of distension (5). Low esophageal compliance will induce greater longitudinal displacement of the distending bag or balloon for a given volume, thereby activating a larger sensory receptive field, and this could result in increased intensity of sensation (15).…”