title: Impairment of secondary peristalsis in Barrett's esophagus by transnasal endoscopy-based testing.
abstract: OBJECTIVE
  To investigate dysfunctions in esophageal peristalsis and sensation in patients with Barrett's esophagus following acid infusion using endoscopy-based testing.
  
  
  METHODS
  First, physiological saline was infused into the esophagus of five healthy subjects, at a rate of 10 mL/min for 10 min, followed by infusion of HCl. Esophageal contractions were analyzed to determine whether the contractions observed by endoscopy and ultrasonography corresponded to the esophageal peristaltic waves diagnosed by manometry. Next, using nasal endoscopy, esophageal sensations and contractions were investigated in patients with, as well as controls without, Barrett's esophagus using the same infusion protocol.
  
  
  RESULTS
  All except one of the propulsive contractions identified endoscopically were recorded as secondary peristaltic waves by manometry. Patients with long segment Barrett's esophagus (LSBE) tended to have a shorter lag time than the control group, although the difference did not reach statistical significance (88 ± 54 s vs 162 ± 150 s respectively, P = 0.14). Furthermore, patients with LSBE had significantly fewer secondary contractions following the infusion of both saline and HCl than did either the control group or patients with short segment Barrett's esophagus (4.1 ± 1.2 vs 8.0 ± 2.8, P < 0.001 and 7.3 ± 3.2, P < 0.01, respectively, following saline infusion; 5.3 ± 1.2 vs 8.4 ± 2.4 and 8.1 ± 2.9 respectively, P < 0.01 for both, following infusion of HCl).
  
  
  CONCLUSIONS
  Using nasal endoscopy and a simple acid-perfusion study, we were able to demonstrate disorders in secondary peristalsis in patients with LSBE.
authors.affiliation: Go Kobayashi, Department of Gastroenterology and Hepatology, Jikei University Daisan Hospital, Tokyo 201-8601, Japan.
authors.forename: Go
authors.initials: G
authors.lastname: Kobayashi
authors.affiliation: Go Kobayashi, Department of Gastroenterology and Hepatology, Jikei University Daisan Hospital, Tokyo 201-8601, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Kaise
authors.affiliation: Go Kobayashi, Department of Gastroenterology and Hepatology, Jikei University Daisan Hospital, Tokyo 201-8601, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Arakawa
authors.affiliation: Go Kobayashi, Department of Gastroenterology and Hepatology, Jikei University Daisan Hospital, Tokyo 201-8601, Japan.
authors.forename: Hisao
authors.initials: H
authors.lastname: Tajiri
mesh_terms: D000328:Adult; D001471:Barrett Esophagus / Q000150:complications* / Q000175:diagnosis; D016022:Case-Control Studies; D004724:Endoscopy / Q000379:methods*; D015154:Esophageal Motility Disorders / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D004947:Esophagus / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006851:Hydrochloric Acid; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009296:Nasal Cavity; D010528:Peristalsis; D011237:Predictive Value of Tests; D011312:Pressure; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D006851:Hydrochloric Acid
keywords: Acid infusion test; Barrett’s esophagus; Esophageal sensation; Secondary peristalsis; Transnasal endoscopy