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Oesophageal bolus transit and clearance by secondary peristalsis in normal individuals

Chen, Chien-Lina b; Szczesniak, Michal M.a; Cook, Ian J.a

European Journal of Gastroenterology & Hepatology: December 2008 - Volume 20 - Issue 12 - p 1129-1135
doi: 10.1097/MEG.0b013e328303bff1
Original Articles: Gastro-Oesophageal Disorders
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Background Secondary peristalsis is important for the clearance of retained refluxate or material from the oesophagus. Combined impedance and manometry can directly detect both oesophageal contraction and bolus transit.

Aim To apply combined impedance and manometry to characterize oesophageal bolus transit and clearance by secondary peristalsis in healthy individuals.

Methods Eleven healthy volunteers underwent combined impedance and manometry with a catheter containing seven impedance-measuring segments and eight water-perfusion pressure transducers. Saline and solid agar boluses of 5 ml were applied for primary peristalsis and secondary peristalsis was stimulated by rapid mid-oesophageal injections of saline.

Results The rate for complete bolus clearance of secondary peristalsis with saline injections was less than that of primary peristalsis with saline swallows (69 vs. 95%, P=0.02). No statistical difference in bolus propagation time between primary and secondary peristalsis was observed (P=0.45). Bolus presence time of secondary peristalsis was significantly longer than that of primary peristalsis for all impedance-measuring segments (all P<0.05). Solid swallows differed from saline swallows with lower rate of complete bolus transit and longer bolus transit time.

Conclusion Our data show that the impedance technique can successfully characterize oesophageal bolus transit and clearance by secondary peristalsis. These findings suggest that secondary peristalsis may be less effective than primary peristalsis regarding oesophageal transit and clearance of a liquid bolus.

aDepartment of Gastroenterology, St George Hospital, University of New South Wales, Sydney, Australia

bDepartment of Medicine, Buddhist Tzu Chi Medical Center, University School of Medicine, Hualien, Taiwan

Correspondence to Chien-Lin Chen, Department of Medicine, Buddhist Tzu Chi Medical Center, 707, Sec. 3, Chung-Yang Rd., Hualien 970, Taiwan

Tel: +886 3 8561825; fax: +886 3 8577161;

e-mail: harry.clchen@msa.hinet.net

Received 14 January 2008 Accepted 7 April 2008

© 2008 Lippincott Williams & Wilkins, Inc.