Division of Gastroenterology, San Diego VA Health Care System & University of California, San Diego, CA 92161, USA.
Neurogastroenterol Motil. 2011 Mar;23(3):201-7, e110. doi: 10.1111/j.1365-2982.2010.01624.x. Epub 2010 Nov 17.
Current understanding is that swallow induces simultaneous inhibition of the entire esophagus followed by a sequential wave of contraction (peristalsis). We observed a pattern of luminal distension preceding contraction which suggested that inhibition may also traverses in a peristaltic fashion. Our aim is to determine the relationship between contraction and luminal distension during bolus transport.
Eight subjects using two solid-state pressure and two ultrasound (US) transducers were studied. Synchronous pressure and US images were obtained with wet swallows and after edrophonium and atropine. Luminal cross-sectional area (CSA) at 2 cm and 12 cm above the lower esophageal sphincter (LES) were recorded. Relationship between pressure and CSA at each site, propagation velocity of peak pressure and peak distension waves were determined. Fluoroscopy coupled with manometry was also performed in five normal subjects.
Esophageal distension precedes contraction wave at both-recorded sites. During distension, esophageal pressure remains constant while luminal CSA increases significantly. The onset and the peak of distension wave traverses in a peristaltic fashion between both sites. A tight coupling exists between the peak distension and peak contraction waves with similar velocities (3.7 cm s(-1) and 3.6 cm s(-1)) of propagation. The degree of distension is greater at 2 cm compared to 12 cm. Atropine and edrophonium reduced and increased the contraction pressure respectively, without affecting the distension wave. Fluoroscopic study confirmed that the wave of distension traverses the esophagus in a peristaltic fashion.
CONCLUSIONS & INFERENCES: Distension and contraction waves are tightly coupled to each other and both traverse in a peristaltic fashion.
目前的认识是，吞咽会同时抑制整个食管，随后是一连串的收缩（蠕动）。我们观察到在收缩之前有一个管腔扩张的模式，这表明抑制也可能以蠕动的方式传播。我们的目的是确定在团块运输过程中收缩和管腔扩张之间的关系。
八名受试者使用两个固态压力传感器和两个超声（US）换能器进行研究。用湿吞咽和依酚氯铵及阿托品后同步获得压力和 US 图像。记录食管下括约肌（LES）上下 2cm 和 12cm 处的管腔横截面积（CSA）。确定每个部位的压力和 CSA 之间的关系、压力波峰和扩张波峰的传播速度。在五个正常受试者中还进行了透视测压联合检查。
食管扩张先于两个记录部位的收缩波。在扩张过程中，食管压力保持不变，而管腔 CSA 显著增加。扩张波的起始和峰值以蠕动方式在两个部位之间传播。峰值扩张波和峰值收缩波之间存在紧密的耦合，传播速度相似（3.7cm/s 和 3.6cm/s）。与 12cm 相比，2cm 处的扩张程度更大。阿托品和依酚氯铵分别降低和增加收缩压，但不影响扩张波。透视研究证实，扩张波以蠕动方式穿过食管。
扩张波和收缩波紧密耦合，两者均以蠕动方式传播。
