Importance of forceful peristalsis in reflux disease.

Peristalsis in the striated muscle of the proximal oesophagus is stimulated by sequential vagus excitation directed from the brainstem and carried to the oesophagus by the recurrent laryngeal branches of the vagus nerve.

Peristalsis in oesophageal smooth muscles is more complex and requires integration of central and peripheral neural mechanisms with smooth muscle properties.

The propagation of peristalsis in the smooth muscle segment involves two peripheral vagus pathways.

One pathway mediates cholinergic excitation (depolarisation) of both longitudinal and circular smooth muscles whilst the other mediates non-adrenergic non-cholinergic inhibition of circular muscles (hyperpolarisation).

Upon swallowing there is almost simultaneous activation of the inhibitory pathway followed by a delayed sequential activation of the excitatory pathway.

This creates a wave of mechanical inhibition (latency) followed by contraction along the oesophagus, constituting peristalsis.

Osteopaths treat high cervical lesions to get stronger peristalsis, so food can be better pushed through the cardia.