ESOPHAGEAL CATHETERIZATION STUDIES. I. THE MECHANISM OF SWALLOWING IN NORMAL SUBJECTS WITH PARTICULAR REFERENCE TO THE VESTIBULE (ESOPHAGO-GASTRIC SPHINCTER)*

Abstract

A technique of esophageal catheterization is described for measuring the motility of the esophagus. The method employs exectromanometers, a constant infusion pump, and a specially prepared set of 6 catheters connected to 3 3-way stopcocks. The pattern of pressure changes obtained from the vestibule is different from that of the body of the esophagus both at rest and during deglutition, indicating that each of these is a separate functioning segment. At rest, there are changing tonus levels in the vestibule, often with sudden generation or release of high pressures. These patterns are independent of those seen in the body of the esophagus and influence the type of response obtained in this segment during swallowing. At the onset of swallowing, the vestibule briefly relaxes and, as peristalsis reaches this segment, a positive pressure wave is developed, following which relaxation again occurs. However, if vestibular resting pressure closely approximates that in the stomach, this initial relaxation does not occur. Conversely, when resting pressure is high, the drop in pressure is greater and so prolonged as to comprise the entire vestibular complex.