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Effect of peristaltic dysfunction on esophageal volume clearance
P J Kahrilas1, W J Dodds, W J Hogan
1Department of Medicine, Northwestern University Medical School, Chicago, Illinois.
Gastroenterology
|January 1, 1988
Summary
Peristaltic dysfunction, including failed or weak contractions, significantly impairs esophageal volume clearance. This dysfunction, common in esophagitis patients, leads to poor clearance of barium swallows.
Area of Science:
- Gastroenterology
- Esophageal Physiology
- Swallowing Disorders
Background:
- Prolonged esophageal acid clearance is linked to peristaltic dysfunction in esophagitis patients.
- Peristaltic dysfunction may impair the esophagus's ability to clear swallowed volumes.
Purpose of the Study:
- To define the impact of common peristaltic dysfunction on esophageal volume clearance.
- To correlate videofluoroscopic and manometric findings in patients with dysphagia or heartburn.
Main Methods:
- Concurrent videofluoroscopy and manometry were used in patients with nonobstructive dysphagia or heartburn.
- Barium bolus clearance was assessed during normal, absent, incomplete, and hypotensive peristaltic contractions.
Main Results:
- A single normal peristaltic wave achieved 100% barium bolus clearance.
- Absent or incomplete peristalsis resulted in minimal to no volume clearance.
- Hypotensive peristalsis led to incomplete clearance via retrograde escape, requiring higher amplitudes distally (25 mmHg) than proximally (12 mmHg).
Conclusions:
- Common peristaltic dysfunctions, such as failed and hypotensive peristalsis, significantly impair esophageal volume clearance.
- Impaired volume clearance due to peristaltic dysfunction likely contributes to prolonged esophageal acid clearance in esophagitis.
- Specific pressure thresholds are needed to prevent retrograde escape and ensure adequate volume clearance.