Double swallow.

Esophageal motility is a complex neuromuscular phenomenon. One intriguing aspect of it is that esophageal peristalsis can be inhibited and even stopped by repeated swallowing. (1) We performed high-resolution manometry on a normal subject to demonstrate this swallow-induced suppression of esophageal motor function (figure). Seconds after a first swallow, a second swallow was initiated promptly, and this halted peristalsis in the preceding swallow. In view of this finding, it is important to wait 20 to 30 seconds between swallows during esophageal manometry studies.

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This finding also has implications for behavioral modification in dysphagic patients. If a patient requires double swallowing to clear a bolus from the hypopharynx, the otolaryngologist should anticipate poor esophageal transit. Moreover, otolaryngologists should instruct patients who have a history of pill-induced esophagitis to take their medications with water and to remain for a time in an upright position. Patients should be strongly encouraged not to double swallow because this increases the likelihood of a nonpropulsive swallow, causing the pill to transiently lodge in the esophagus.

Reference

(1.) Sifrim D, Janssens J, Vantrappen G. A wave of inhibition precedes primary peristaltic contractions in the human esophagus. Gastroenterology 1992:103:876-82.

Gregory N. Postma, MD; Lori M. Burkhead, PhD, CCC-SLP; William H. Moretz III, MD

From the Center for Voice and Swallowing Disorders. Department of Otolaryngology. Medical College of Georgia, Augusta