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. 1994 Feb;35(2):165–171. doi: 10.1136/gut.35.2.165

Diminished oesophageal traction forces with swallowing in gastro-oesophageal reflux disease and in functional dysphagia.

D Williams 1, D G Thompson 1, M Marples 1, L Heggie 1, T O'Hanrahan 1, J Bancewicz 1
PMCID: PMC1374489  PMID: 8307465

Abstract

Relations between primary oesophageal peristaltic amplitude and traction force were studied in 30 normal volunteers, 12 patients with functional dysphagia, and 48 patients with gastro-oesophageal reflux disease, using a new intraluminal strain gauge device. Forces generated by swallowing in the normal oesophagus were 42 (35-60) g (median and interquartile range), a close positive correlation existing between traction force and contractile amplitude for each subject (r = 0.5 (0.38-0.6). Traction force increased with increasing balloon volume from 62 (50-73) g at 2 ml to 86 (70-105) g at 4 ml (p < 0.05), indicating distension related modulation of peristaltic force. Patients with oesophagitis generated lower traction forces on swallowing 30 (20-40) g compared with the normal subjects (p < 0.01), the degree of impairment being greatest in those patients with the most severe mucosal damage. Patients with gastro-oesophageal reflux without endoscopic oesophagitis also showed abnormal forces (32 22-38) g p < 0.01 v controls), which were similar to those patients with mild oesophagitis but were greater than those with severe oesophagitis (p < 0.05). In patients with functional dysphagia, forces were also impaired (28 (10-60) g p < 0.05 v controls) despite normal standard manometry. Our results show that measurement of the traction force generated by primary peristalsis provides information about oesophageal neuromuscular function that is not demonstrable by manometry alone and can be abnormal in patients with oesophageal symptoms in whom standard techniques are normal.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brasseur J. G. A fluid mechanical perspective on esophageal bolus transport. Dysphagia. 1987;2(1):32–39. doi: 10.1007/BF02406976. [DOI] [PubMed] [Google Scholar]
  2. HWANG K. Mechanism of transportation of the content of the esophagus. J Appl Physiol. 1954 Jun;6(12):781–796. doi: 10.1152/jappl.1954.6.12.781. [DOI] [PubMed] [Google Scholar]
  3. Hewson E. G., Ott D. J., Dalton C. B., Chen Y. M., Wu W. C., Richter J. E. Manometry and radiology. Complementary studies in the assessment of esophageal motility disorders. Gastroenterology. 1990 Mar;98(3):626–632. [PubMed] [Google Scholar]
  4. Howard P. J., Pryde A., Heading R. C. Oesophageal manometry during eating in the investigation of patients with chest pain or dysphagia. Gut. 1989 Sep;30(9):1179–1186. doi: 10.1136/gut.30.9.1179. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. INGELFINGER F. J. Esophageal motility. Physiol Rev. 1958 Oct;38(4):533–584. doi: 10.1152/physrev.1958.38.4.533. [DOI] [PubMed] [Google Scholar]
  6. Kahrilas P. J., Dodds W. J., Hogan W. J. Effect of peristaltic dysfunction on esophageal volume clearance. Gastroenterology. 1988 Jan;94(1):73–80. doi: 10.1016/0016-5085(88)90612-9. [DOI] [PubMed] [Google Scholar]
  7. Kjellén G., Svedberg J. B., Tibbling L. Solid bolus transit by esophageal scintigraphy in patients with dysphagia and normal manometry and radiography. Dig Dis Sci. 1984 Jan;29(1):1–5. doi: 10.1007/BF01296854. [DOI] [PubMed] [Google Scholar]
  8. Mellow M. H. Esophageal motility during food ingestion: a physiologic test of esophageal motor function. Gastroenterology. 1983 Sep;85(3):570–577. [PubMed] [Google Scholar]
  9. Mughal M. M., Marples M., Bancewicz J. Scintigraphic assessment of oesophageal motility: what does it show and how reliable is it? Gut. 1986 Aug;27(8):946–953. doi: 10.1136/gut.27.8.946. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. PERT J. H., DAVIDSON M., ALMY T. P., SLEISENGER M. H. Esophageal catheterization studies. I. The mechanism of swallowing in normal subjects with particular reference to the vestibule (esophago-gastric sphincter). J Clin Invest. 1959 Feb;38(2):397–406. doi: 10.1172/JCI103814. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Pope C. E., 2nd, Horton P. F. Intraluminal force transducer measurements of human oesophageal peristalsis. Gut. 1972 Jun;13(6):464–470. doi: 10.1136/gut.13.6.464. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Ren J., Schulze-Delrieu K. Movement of wax particles by contractions in the isolated opossum esophagus. Am J Physiol. 1990 Jan;258(1 Pt 1):G164–G170. doi: 10.1152/ajpgi.1990.258.1.G164. [DOI] [PubMed] [Google Scholar]
  13. Russell C. O., Bright N., Buthpitiya G., Alexander L., Walton C., Whelan G. Oesophageal propulsive force and its relation to manometric pressure. Gut. 1992 Jun;33(6):727–732. doi: 10.1136/gut.33.6.727. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Russell C. O., Hill L. D., Holmes E. R., 3rd, Hull D. A., Gannon R., Pope C. E., 2nd Radionuclide transit: a sensitive screening test for esophageal dysfunction. Gastroenterology. 1981 May;80(5 Pt 1):887–892. [PubMed] [Google Scholar]
  15. Russell C. O., Whelan G. Oesophageal manometry: how well does it predict oesophageal function. Gut. 1987 Aug;28(8):940–945. doi: 10.1136/gut.28.8.940. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Schoen H. J., Morris D. W., Cohen S. Esophageal peristaltic force in man. Response to mechanical and pharmacological alterations. Am J Dig Dis. 1977 Jul;22(7):589–597. doi: 10.1007/BF01073076. [DOI] [PubMed] [Google Scholar]
  17. Williams D., Thompson D. G., Marples M., Heggie L., O'Hanrahan T., Mani V., Bancewicz J. Identification of an abnormal esophageal clearance response to intraluminal distention in patients with esophagitis. Gastroenterology. 1992 Sep;103(3):943–953. doi: 10.1016/0016-5085(92)90028-w. [DOI] [PubMed] [Google Scholar]

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