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Figure 2-11 Primary peristalsis appears after voluntary d├ęglutitions (wet swallow [WS] 1-3). When the esophagus is perfused with acid, spontaneous tertiary activity (SP) appears with a longer repetitive contraction that ends by a secondary contraction. A voluntary swallow under acid perfusion is followed by a tertiary wave response (WS 5).

Figure 2-11 Primary peristalsis appears after voluntary d├ęglutitions (wet swallow [WS] 1-3). When the esophagus is perfused with acid, spontaneous tertiary activity (SP) appears with a longer repetitive contraction that ends by a secondary contraction. A voluntary swallow under acid perfusion is followed by a tertiary wave response (WS 5).

Figure 2-12 A and B, Tertiary contractions appear in response to deglutition. These contractions are abnormal. (WS, wet swallow.)

WS WS

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Figure 2-13 Spontaneous tertiary activity. These contractions may represent abnormal activity. They also may be strongly influenced by psychological factors.

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Figure 2-13 Spontaneous tertiary activity. These contractions may represent abnormal activity. They also may be strongly influenced by psychological factors.

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Figure 2-14 A, Normal lower esophageal sphincter (LES) upon swallowing. (WS, wet swallow.) The resting pressure falls to the level of intragastric pressure. The relaxation period is coordinated with the contraction in the distal esophagus. The passage of the peristaltic wave through the sphincter area closes the esophagogastric junction after the bolus is in the stomach. The sphincter then returns to its normal resting pressure. B, Radial configuration of the lower esophageal sphincter. (A, anterior; L, left; LA, left anterior; LP, left posterior; P, posterior; R, right; RA, right anterior; RP, right posterior.) (From Winans, C.S.: Manometric asymmetry of the lower esophageal high pressure zone. Digest Dis., 22:348, 1977, with permission.)

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