title: Quantitative differences between primary and secondary peristaltic contractions of the esophagus.
abstract: OBJECTIVE
  Differences in contraction characteristics between primary and secondary peristalsis have only been scarcely studied. Recently new measures of contractile activity in the human esophagus were developed. The study aims were to use combined manometry and impedance planimetry [pressure-cross-sectional area (P-CSA)] recordings from healthy volunteers to examine esophageal peristalsis, and, furthermore, to investigate the effect of the motility enhancing drug erythromycin to study differential effects on the two types of contractions.
  
  
  METHODS
  Sixteen healthy volunteers participated in the study [mean age 23 (range, 19-34) years, 6 females]. An esophageal probe with a bag for CSA measurement was positioned 10 cm above the lower esophageal sphincter. Bag volume was increased stepwise from 5 to 25 ml before and after intravenous infusion of 250 mg erythromycin. Swallow-evoked primary and distension-evoked secondary esophageal peristalsis were compared with regard to (1) pressure amplitude, (2) CSA amplitude, (3) preload tension (wall tension before an evoked contraction), (4) contractile tension, and (5) work outputs.
  
  
  RESULTS
  Primary peristalsis induced more efficient contractions as the contraction amplitudes, work output and contractile tension were higher compared to secondary peristalsis (P < 0.001). Erythromycin induced change in CSA during distension-evoked secondary peristalsis (CSA before 212.9 ± 26.8 vs. after 180.5 ± 23.3, P < 0.05). The sensitivity to esophageal distension increased with the distending volume both before and during erythromycin. The sensitivity was not changed by erythromycin (P = 0.6).
  
  
  CONCLUSIONS
  Esophageal primary peristaltic contractions were more forceful with longer duration, and higher work output compared to secondary peristalsis contractions. Erythromycin affected peristalsis only to a minor degree.
authors.affiliation: Giome Academia, Institute of Clinical Medicine, Aarhus University Hospital, Skejby, Brendstrupgaardsvej, 8200, Aarhus, Denmark, liao.donghua@ki.au.dk.
authors.forename: Donghua
authors.initials: D
authors.lastname: Liao
authors.forename: Anne Lund
authors.initials: AL
authors.lastname: Krarup
authors.forename: Flemming Holbæk
authors.initials: FH
authors.lastname: Lundager
authors.forename: Asbjørn Mohr
authors.initials: AM
authors.lastname: Drewes
authors.forename: Hans
authors.initials: H
authors.lastname: Gregersen
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D004917:Erythromycin; D004947:Esophagus / Q000502:physiology*; D005260:Female; D005765:Gastrointestinal Agents; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D010528:Peristalsis; D055815:Young Adult
chemical_list: D005765:Gastrointestinal Agents; D004917:Erythromycin