Secondary esophageal peristalsis is preserved in patients with posterior laryngitis

Abstract

Secondary peristalsis not only helps volume clearance of refluxate from the esophagus, it may help prevent entry of refluxate into the pharynx and its complications such as reflux laryngitis. Previous studies have documented abnormalities of esophageal secondary peristalsis in patients with peptic esophagitis (Schoeman MN, Holloway RH; Gut 1995;36:499-504). However, secondary esophageal peristalsis in patients with supraesophageal complications of reflux disease has not been systematically studied. Aims: To study the frequency stimulation and parameters of esophageal secondary peristalsis in patients with posterior laryngitis (PL). Methods: We studied 14 PL (45_ 5 yrs) documented by stroboscopy and 11 healthy age matched controls (46 -+ 6 yrs). Controls and PLs underwent transnasal unsedated EGD and did not exhibit any esophageal abnormalities. Upper esophageal sphincter (UES) pressure was monitored by a sleeve assembly incorporating an injection port 7cm distal to the sleeve. Esophageal body and LES pressures were measured by a LES sleeve assembly incorporating recording sites at 0, 3, 6, 9 and 15cm proximal to the sleeve. Secondary peristalsis was induced by abrupt injection of incrementally increased volumes of air (5mL) into mid esophagus. Intraluminal pressures were recorded using a minimally compliant pneumohydraulic perfusion system (Arndorfer Specialties, Greendale, WI). Results: Secondary peristalsis could not be elicited by injection of any volume (up to 60mL) in 3 patients (ages 57, 63, and 72 yrs) and 2 normal controls (ages 69 and 76 yrs). These 5 had normal primary peristalsis. The threshold volume of air required to stimulate secondary peristalsis in PL (15_+2.5mL, SE) was similar to that of controls (11.6_+2.5mL, SE). Threshold volume did not induce belching. The parameters of secondary peristalsis were similar in both groups (Table). In both groups, parameters of secondary peristalsis were similar to primary peristalsis induced by swallowing 5mL of water. UES response to the injection of threshold volume that induced secondary peristalsis in PL was contraction in 58% of the trials, partial relaxation in 3% and no response in 39%. Findings were similar for the controls. Lower esophageal sphincter response to injection of threshold volume resulted in complete relaxation in both patients and controls.