Antiperistalsis in the upper third of the esophagus in man.

Abstract

The subject of this investigation was a child of thirteen years who, at the age of four, swallowed strong acids, and in consequence developed almost complete cicatricial stenosis of the esophagus, the upper end of the occlusion being about 5 cm. below the level of the sternum. During the nine years the child had taken nourishment almost exclusively by a gastrostomy tube. For months at a stretch not even a drop of water could pass through the esophagus into the stomach. Occasionally an opening of 2 to 3 mm. diameter appeared, allowing water and milk to pass from the mouth into the stomach. Evidently a chronic spasm of the injured portion of the esophagus had developed on the top of the mechanical stricture. During an investigation of possible means of controlling the esophageal spasm, the child frequently swallowed small quantities of barium milk while fluoroscopic observations were being made. There was little or no permanent dilation of the end of the esophagus above the occlusion. The presence of the barium milk in this region led at once to vigorous movements of the esophagus resembling the movements of the small intestine above an obstruction, as originally described by Cannon. 1 One could make out local rings of constriction (segmentation movements) at different levels, as well as regular peristalsis. There frequently appeared vigorous antiperistalsis, forcing some of the barium milk towards and even into the mouth. The esophagus was able to empty itself completely in this way. We could secure no evidence that the mechanism was under voluntary control. The antiperistalsis did not induce any special sensation, such as nausea. Material in the upper end of the esophagus was felt as “something stuck in the threat,” whether or not antiperistalsis was present.