Esophageal solid bolus transit: Studies using concurrent videofluoroscopy and manometry

OBJECTIVE: Our aim was to assess the efficacy and mechanism of solid bolus transit through the esophagus. METHODS: Eight healthy volunteers were studied with concurrent manometry an d videofluoroscopy while swallowing 5 ml liquid barium, a 5-6 mm diameter b read ball, and 4 g chewed bread in both a supine and upright posture. As ma ny as four successive swallows were performed until clearance was achieved. RESULTS: The esophageal clearance of liquid barium was 100% with the first swallow. Clearance of the unchewed bread ball occurred with the first swall ow in only 6.7% of trials in the upright posture and 5.9% in the supine pos ture. After four swallows, clearance was 100% and 52.9% in the upright and supine postures, respectively. Chewed bread was more readily cleared than u nchewed bread, with 100% clearance after two swallows in the upright postur e and 91% clearance after four swallows in the supine posture. The most com mon locus of bread stasis was at the aortic arch and carina. The bread bolu ses were noted to move more effectively when localized in the head as oppos ed to the tail of the bolus composite. Nonocclusive contractions often occu rred at the bolus tail despite the increased peristaltic amplitude seen wit h the chewed bread. Failed peristalsis, a frequent cause for solid clearanc e failure, was observed during 30% of all bread swallows. This usually occu rred distal to the stopping point of the bolus, suggesting it to be the res ult rather than the cause of impaired transit. CONCLUSIONS: Although infrequently perceived by these normal subjects and i n contradistinction to liquid clearance, bread is rarely cleared from the e sophagus with a single swallow. Mastication and an upright posture facilita te the esophageal transport of solids. Bolus composition and impaired bolus transit alter the amplitude and conductance of peristalsis. Manometric dat a pertaining to liquid clearance through the esophagus do not readily apply to bread. (Am J Gastroenterol 1999;94:1457-1463. (C) 1999 by Am. Coll. of Gastroenterology).