Repetitive antegrade contraction: A novel response to sustained esophageal distension is modulated by cholinergic influence

Dustin A. Carlson*, Wenjun Kou, Melina Masihi, Shashank Acharya, Alexandra J. Baumann, Erica N. Donnan, Peter J. Kahrilas, John E. Pandolfino

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


A unique motor response to sustained esophageal distension, repetitive antegrade contractions (RACs), is observed using functional luminal imaging probe (FLIP) panometry. However, physiological mechanisms related to this response are unexplored. This study aimed to evaluate the impact of cholinergic inhibition with atropine on the esophageal contractile response to sustained distention, including RACs, among healthy volunteers. Eight asymptomatic volunteers (ages 22-45 yr) were evaluated in a crossover study design with 16-cm FLIP positioned across the esophagogastric junction and distal esophagus during sedated upper endoscopy. The FLIP study involving stepwise volumetric distension was performed twice in each subject, at baseline, and again after atropine (15 μg/kg) was administered intravenously. FLIP panometry data were analyzed to assess the contractile response to distension. Antegrade contractions, lumen-occluding contractions, and a RAC pattern were observed in 8/8, 8/8, and 7/8 (88%) subjects, respectively, at baseline and in 5/8 (63%), 2/8 (25%), and 2/8 (25%) subjects after atropine. The rate of contractions in the RAC pattern was similar (6-7 contractions per minute) before and after atropine. Compared with the baseline study, distension-induced contractility was triggered at higher fill volumes after atropine. FLIP pressures were lower in response to volumetric filling after atropine than at baseline. The vigor and triggering of the esophageal contractile response to distension is reduced by cholinergic inhibition in asymptomatic controls. The observation that the rate of contractions did not change when patients developed repetitive contractile responses suggests that this rate is not modified by cholinergic inhibition once contractility is triggered. NEW & NOTEWORTHY Repetitive antegrade contraction, a unique, patterned, motor response to sustained esophageal distension, is observed on functional luminal imaging probe panometry in healthy controls and patients with normal esophageal motility; however, the mechanisms related to this response are unclear. Among healthy, asymptomatic volunteers, cholinergic inhibition with atropine reduced the vigor and triggering of distension-induced esophageal contractility, although the rate at which contractions occurred in a repetitive antegrade contraction pattern was unchanged by atropine.

Original languageEnglish (US)
Pages (from-to)G696-G702
JournalAmerican Journal of Physiology - Gastrointestinal and Liver Physiology
Issue number6
StatePublished - Dec 2020


  • Anticholinergic
  • Manometry
  • Motility
  • Peristalsis

ASJC Scopus subject areas

  • Gastroenterology
  • Physiology (medical)
  • Physiology
  • Hepatology


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