INTEGRITY AND CHARACTERISTICS OF SECONDARY ESOPHAGEAL PERISTALSIS IN PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE

Secondary peristalsis contributes to oesophageal acid clearance. The a im of the study was to evaluate the integrity and characteristics of s econdary peristalsis in patients with gastro-oesophageal reflux diseas e. Studies were performed in 22 patients with reflux disease and 20 ag e matched controls. Oesophageal motility was recorded at 3 cm interval s along the oesophageal body. Primary peristalsis was tested with 5 mi water swallows. Secondary peristalsis was stimulated with 10 mi bolus es of air and water injected in the mid-oesophagus and by 5 second dis tensions with a 3 cm balloon at the same level. It was found that prim ary peristalsis was normal in 19 of 20 control subjects and in 14 of 2 2 patients with reflux disease. In patients with reflux disease, intac t secondary peristalsis was triggered infrequently by air and water di stension (median success rate of 0% for both stimuli) and occurred sig nificantly less frequently than in control subjects (50% and 30% respe ctively). The frequency of balloon induced secondary peristalsis, howe ver, was similar in the two groups (0% controls, 20% reflux disease). The major pattern of failure of secondary peristalsis was the complete absence of any oesophageal secondary peristaltic response. The amplit udes of the intact secondary peristaltic responses were not significan tly different for the two groups. Peristaltic velocity for air and bal loon induced secondary peristalsis was also similar in control subject s and patients with reflux disease whereas water induced secondary per istalsis was slower in the reflux patients. In conclusion, patients wi th reflux disease exhibit a pronounced defect in the triggering of sec ondary peristalsis.