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Is peristalsis always normal ?
R. W. McCallum (Charlottesville)
I will first review comparison of contraction amplitudes at 5 and 10 cm above the LES in a series of 30 normal volunteers and in patients who were symptomatic for the spectrum of non-cardiac chest pain and, by manometric criteria, qualified for the diagnosis of high amplitude (nutcracker esophagus) [1]. Adopting a standard of mean plus deviations, we concluded that a mean amplitude of 180 mm Hg was present in the high amplitude peristaltic patients compared to 85 mm Hg for the normal subjects when measuring amplitude 5 cm above the LES (figure 1 - A and B).
Figure 1 A. Schematic representation of esophageal motor function. The lower esophageal sphincter relaxes at the onset of swallowing. A propagated contraction is shown from the proximal esophagus through the lower esophageal sphincter.
Figure 1 B. Esophageal contraction amplitudes at 5 and 10 cm above the LES in normal subjects (n = 30) and in patients with HAPC (n = 20). Normals and patients differ significantly at both sites. For each group the values at 5 and 10 cm differ significantly.
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