Topography of the esophageal peristaltic pressure wave

Topographic plots constructed from conventional esophageal manometric waves were examined in 12 healthy volunteers to better understand spatial relationships of peristaltic contractions. Typical postdeglutitive waves were spatially interconnected using a computerized gridding and plotting system. Contour plots of the resultant peristaltic contraction revealed a consistent separation of a proximal pressure segment from the prominent distal contraction at 21.7 +/- 1.3% of the esophageal length. A second trough in the contraction sequence was found in 11 (91.7%) of the subjects at 64.0 +/- 2.7% of esophageal length separating the distal (smooth muscle) esophagus into two contraction segments. Similar topographic studies were also performed in eight symptomatic patients with frequent double-peaked waves. Poor alignment of the two distal contraction segments was observed in six (75%) of the eight patients. These topographic plots demonstrate previously unrecognized wave relationships and suggest that two neuromuscular contraction units can be detected in the distal smooth muscle esophagus. This technique should be useful in understanding altered relationships of these units under differing physiological conditions or with disease.