The effect of gravity on oesophageal peristalsis in humans

Many mammalian species including non-human primates consume water in a body position not aided by gravity and it has been conjectured that oesophageal peristalsis overcomes gravity in humans. The purpose of this study was to determine the effects of gravity on oesophageal peristalsis in humans in response to water swallows. Six females (30-43 years old) and six males (27-46 years old) without oesophageal symptoms underwent oesophageal motility testing with intraluminal microtransducers placed 5, 7.5, 10 and 15 cm above the lower oesophageal sphincter. Subjects received ten 5 mL water swallows every 30 sec in the supine, standing, and head down (30 degrees) prone positions which were counterbalanced. Oesophageal contractile pressure (115, 98, 126 mmHg), duration (3.5, 3.0, 3.7 sec), onset velocity (4.7, 4.9, 4.7 cm sec-1), peak velocity (5.1, 4.8, 4.1 cm sec-1), average upstroke (dP/dT) (78, 75, 84 mmHg sec-1), or maximum upstroke (132, 120, 141 mmHg sec-1) were not significantly different among the head down prone, upright and supine positions, respectively. The frequency of abnormal contractile activity was statistically different among the positions. More abnormal contractions (i.e. simultaneous, retrograde, non-transmitted) occurred in the upright position (26%) when compared to either the supine (12%, P = 0.005) or head down prone (13%, P = 0.013) positions. The oesophagus tends to function normally to water swallows when unassisted by gravity. Oesophageal peristaltic dysfunction to water swallows may be more pronounced when assisted by the force of gravity.