Esophageal motility during food ingestion: a physiologic test of esophageal motor function

It is unknown whether esophageal motility, as assessed by standard motility testing, bears close relationship to motility occurring during food ingestion. Certainly, many patients, while reporting symptoms during food ingestion, are asymptomatic during standard motility testing; thus, a direct link between abnormal motility and symptomatology is often lacking. Twelve normal subjects and 5 patients with symptomatic esophageal motility disorders, therefore, underwent motility testing during upright ingestion of a meal which consisted of beef cubes and gravy. In normals, contraction parameters during food ingestion could not have been predicted by values obtained during standard testing (r = 0.2, p greater than 0.05). All 5 patients, although asymptomatic during standard testing, reported dysphagia during food ingestion. Evidence of abnormal motility could be observed simultaneously. Patterns of abnormality included nonperistaltic contractions (7.2 +/- 2.5 episodes per meal), instances of incomplete lower esophageal sphincter relaxation (2.8 +/- 0.8 episodes per meal), and instances of lack of complete lower esophageal sphincter relaxation during ongoing esophageal contractions (4.6 +/- 1.0 episodes). These abnormalities were significantly more frequent in patients than in controls (p less than 0.001), and most had not been observed during standard testing in the patients. In addition, bethanechol significantly increased abnormal motility and increased dysphagia during food ingestion in the patients, but was without significant effect in controls. It was concluded, therefore, that recording of esophageal motility during upright food ingestion appears to be of value in the diagnosis and characterization of motor abnormalities in patients with symptoms of esophageal motor dysfunction.