The rhythm and rate of distension-induced esophageal contractility: A physiomarker of esophageal function

Dustin A. Carlson*, Wenjun Kou, John E. Pandolfino

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Background: Distention of the esophagus elicits a unique pattern of repetitive contractions in healthy controls. We aimed to assess the rhythm and rate of distension-induced contractile patterns between achalasia and controls and identify factors that distinguish the normal contractile response to distension. Methods: Twenty asymptomatic controls and 140 adult patients with treatment-naïve achalasia defined by HRM (29 type I, 81 type II, 30 type III) were prospectively evaluated with functional luminal imaging probe (FLIP) during sedated endoscopy. 16-cm FLIP balloons were positioned within the distal esophagus during stepwise balloon distension. Functional luminal imaging probe panometry studies were retrospectively analyzed using a customized program. Key results: All controls had contractility in a repetitive antegrade contraction (RAC) pattern with a rate of mean (10-90th) 6 (4-8) contractions per minute. 19/20 controls had > 6 consecutive antegrade contractions (ACs), that is, duration > 6 ACs, >6 cm in length, at a rate of 6 ± 3 contractions per minute (met the “Rule-of-6s”). 50 achalasia patients had repetitive contractions that occurred at a rates of 11 (7 - 15) ACs per minute; P <.001 compared with controls, or 12 (8-15) repetitive retrograde contractions per minute. Only 1/140 achalasia patients had a contractile response that met the “Rule-of-6s.”. Conclusion: The normal contractile response to sustained distention is associated with > 6 RACs with a consistent rate of 6 ± 3 per minute, which was exceptionally rare in achalasia. These findings support that the RAC pattern is disrupted in achalasia and the faster rate may be a manifestation of abnormal inhibition and/or a reduced refractory period.

Original languageEnglish (US)
Article numbere13794
JournalNeurogastroenterology and Motility
Issue number5
StatePublished - May 1 2020


  • Achalasia
  • FLIP
  • dysphagia
  • impedance
  • manometry
  • peristalsis

ASJC Scopus subject areas

  • Endocrine and Autonomic Systems
  • Gastroenterology
  • Physiology


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