Esophageal Contractions After Wet and Dry Swallows in Patients With Esophagitis, Chagas' Disease and Idiopathic Achalasia

BACKGROUND In normal subjects the distal esophageal response to dry swallows differs from that of wet swallows. Our aim in this investigation was to compare the esophageal contractions of the proximal and distal esophageal body to wet and dry swallows. METHODS We studied the esophageal contractions of eight patients with idiopathic achalasia, 37 patients with Chagas' disease, 28 patients with esophagitis, and 31 normal volunteers using manometric examination with continuous perfusion. The esophageal contractions were measured at 2 cm (proximal) and 22 cm (distal) from the upper esophageal sphincter. Five swallows of a 5 ml bolus of water alternated with 5 dry swallows were performed. RESULTS In the proximal esophagus there was no difference between wet and dry swallows. In patients with esophagitis and volunteers the contractions in the distal esophagus had greater amplitude with wet swallows than with dry swallows. Contraction amplitude was lower than the amplitude of the other groups, in both the proximal and distal esophageal body in achalasia, and in distal esophageal body in Chagas' disease. The interval between the upstroke of contractions in the proximal and distal esophageal body was longer in volunteers and patients with esophagitis than in patients with Chagas' disease and achalasia. CONCLUSIONS Wet swallows cause higher amplitude of contraction in distal esophagus than dry swallows, which is not seen in diseases with impairment of esophageal innervation (achalasia and Chagas' disease). In the proximal esophagus there is no difference in contractions caused by wet or dry swallows.