Are tertiary waves a sign of disturbed esophageal motility ?
L. Tibbling (Linkoping)
Esophageal motor activity can be described in terms of primary peristaltic contractions, secondary peristaltic contractions, and tertiary contractions. The contraction wave which starts high up in the pharynx and progresses down the whole length of the esophagus is initiated by the voluntary act of swallowing. This wave is called primary peristalsis (figure 1).
Secondary peristalsis is a peristaltic contraction of the esophageal circular muscle which begins without swallowing. This secondary wave originates in the esophagus as a result of distension and gives a similar manometric pattern as primary peristalsis. Tertiary waves are defined as contractions which occur simultaneously at different levels of the esophagus . They represent nonperistaltic, contractions either of isolated (figure 2) or repetitive (figure 3) character and can be elicited spontaneously or by swallowing. Tertiary waves can appear segmentally or in the entire esophageal body.
Spontaneous tertiary waves