Terminology of Esophageal Motility

Primary Peristalsis

Primary peristalsis refers to the propulsive waves of contraction that are evoked by normal swallowing and travel down the entire esophagus. They can be observed during endoscopy when the patient swallows.

Secondary Peristalsis

This refers to propulsive contractions that are triggered by local stimuli within the esophagus and are transmitted by normal peristaltic activity. They may be initiated by a large food bolus, reflux, or by endoscopy. Physiologically, secondary peristalsis is one of the clearance mechanisms of the esophagus. Absence of this activity may signify a motility disorder (achalasia, scleroderma).

Tertiary Peristalsis

This refers to nonpropulsive, irregular contractions that may occur synchronously in some circumstances. They may be observed during endoscopy in a healthy subject, and their physiological function is unknown.

Fig. 2.24 Esophageal peristalsis

Pharynx

Upper esophageal sphincter

Swallowing

Tubular esophagus

Lower I esophageal -j sphincter

Fig. 2.24 Esophageal peristalsis

Swallowing

Upper esophageal sphincter

Tubular esophagus

Lower I esophageal -j sphincter

mm Hg

150 120 90 60 30 0

60 30 0

60 30 0

60 30 0

b - d Peristaltic contractions in the esophagus b - d Peristaltic contractions in the esophagus

Tertiary Contractions Grading

a Pressures measured in the esophagus during normal swallowing d a Pressures measured in the esophagus during normal swallowing

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