A WAVE OF INHIBITION PRECEDES PRIMARY PERISTALTIC CONTRACTIONS IN THE HUMAN ESOPHAGUS

Animal studies have shown that primary esophageal peristalsis is preceded by a wave of inhibition spreading rapidly down the esophagus and lasting longer in more distal segments. In humans, its presence in the esophageal body cannot be demonstrated manometrically because of the absence of tone. To study deglutitive inhibition in humans, an artificial high-pressure zone was created by inflating an intraesophageal balloon to a critical level. The pressure changes at the interface between the balloon and the esophageal wall at various levels along the esophagus were measured. In this artificial high-pressure zone, deglutition induced a relaxation beginning simultaneously at various levels of the esophagus but lasting progressively longer in progressively more distal segments. Latency from onset of deglutition to onset of relaxation at 13 cm and 8 cm above the lower esophageal sphincter and at the lower esophageal sphincter was 0.06 ± 0.19 seconds, 0.10 ± 0.31 seconds, and 0.89 ± 0.53 seconds, respectively; latency to contraction was 4.45 ± 0.54 seconds, 6.04 ± 0.79 seconds, and 9.14 ± 1.04 seconds, respectively. This is the first direct evidence that deglutition produces in the human esophagus a wave of inhibition that precedes the primary peristaltic contraction. © 1992.