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Distal Contraction Latency: A Measure of Propagation Velocity Optimized for Esophageal Pressure Topography Studies

Roman, Sabine MD, PhD1; Lin, Zhiyue MS1; Pandolfino, John E MD, MSCI1; Kahrilas, Peter J MD1

American Journal of Gastroenterology: March 2011 - Volume 106 - Issue 3 - p 443–451
doi: 10.1038/ajg.2010.414
ORIGINAL CONTRIBUTIONS: ESOPHAGUS
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OBJECTIVES: A defining feature of peristalsis is propagation velocity, which determines the timing of the distal contraction relative to the swallow. This study aimed to exploit a coordinate-based strategy to quantify the normal latency of the distal esophageal contraction as a measure of propagation velocity optimized for high-resolution esophageal pressure topography (EPT) studies.

METHODS: EPT studies for 75 healthy volunteers were merged in a computer simulation. Swallows were synchronized and analyzed as a 100 × 200 pixel grid that normalized esophageal length from the pharynx to the stomach for a 20-s period to first calculate a composite for each individual and then to establish normative values for the morphology and latency of the distal contraction among individuals.

RESULTS: Stereotyped landmarks in composite EPT studies were pressure troughs in the proximal and distal esophagus isolating the distal segment and the contractile deceleration point (CDP) localizing the termination of peristalsis in the distal segment. Distal contractile latency was timed to the CDP (median 6.0 s, 95% confidence interval 4.8–7.6 s) and to lower esophageal sphincter (LES) contraction (median 9.2 s, 95% confidence interval 6.5–11.5 s). Illustrative examples are shown of rapidly conducted contractions with normal or short latency, suggesting short latency to be the preferable EPT metric of rapid propagation.

CONCLUSIONS: The proposed scheme, utilizing the topographic coordinates of contraction relative to the swallow as an alternative to conventional measures of peristaltic velocity, lays the foundation for a physiologically grounded classification of peristaltic abnormalities in EPT. Future studies will test the clinical utility of this scheme.

1Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

Correspondence: Sabine Roman, Division of Gastroenterology, Department of Medicine, Feinberg School of Medicine, Northwestern University, 676 St Clair Street, Suite 1400, Chicago, Illinois 60611-2951, USA. E-mail: roman.sabine@gmail.com

published online 26 October 2010

Received 13 July 2010; accepted 22 September 2010

© The American College of Gastroenterology 2011. All Rights Reserved.
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