scholarly journals Maturation of upstream and downstream esophageal reflexes in human premature neonates: the role of sleep and awake states

2013 ◽  
Vol 305 (9) ◽  
pp. G649-G658 ◽  
Author(s):  
Sudarshan R. Jadcherla ◽  
Chin Yee Chan ◽  
Soledad Fernandez ◽  
Mark Splaingard
Keyword(s):  
Apple Juice ◽  
Upper Esophageal Sphincter ◽  
Sensory Thresholds ◽  
Stimulus Response ◽  
Sensory Motor ◽  
Postmenstrual Age ◽  
Esophageal Sphincter ◽  
Secondary Peristalsis ◽  
Motor Effects

We tested the hypothesis that the sensory-motor characteristics of aerodigestive reflexes are dependent on stimulus type and volumes, sleep or awake states, and maturation. Thirteen neonates were studied at 33.6 ± 0.5 wk ( time 1) and 37.3 ± 0.5 wk ( time 2) postmenstrual age using multimodal provocative esophageal manometry concurrent with video polysomnography. Effects of graded volumes (399 infusions at time 1, 430 infusions at time 2) of midesophageal stimulation with air, water, and apple juice on the sensory thresholds and recruitment frequency of upper esophageal sphincter (UES), esophageal body, and lower esophageal sphincter (LES) reflexes were investigated during sleep and awake states. Sensory thresholds for aerodigestive reflexes between maturational stages were similar. Increased frequency recruitment of UES contractile reflex, LES relaxation reflex, and peristaltic reflexes were noted at time 2 (all, P < 0.05). Graded stimulus-response relationships were evident at time 1 and time 2 during awake and sleep states ( P < 0.05). Secondary peristalsis vs. esophago-deglutition response proportions during sleep at time 1 vs. time 2 ( P = 0.001) and awake vs. sleep at time 2 ( P = 0.02) were distinct. We concluded that sensory-motor effects of esophageal mechanosensitivity, osmosensitivity, and chemosensitivity are advanced in sleep with maturation. Sleep further modulates the frequency recruitment and the type of aerodigestive reflexes.

scholarly journals The role of the superior laryngeal nerve in esophageal reflexes

2012 ◽  
Vol 302 (12) ◽  
pp. G1445-G1457 ◽  
Author(s):  
I. M. Lang ◽  
B. K. Medda ◽  
S. Jadcherla ◽  
R. Shaker
Keyword(s):  
Motor Nerve ◽  
Superior Laryngeal Nerve ◽  
Esophageal Pressure ◽  
Upper Esophageal Sphincter ◽  
Laryngeal Nerve ◽  
Cervical Esophagus ◽  
Proximal Esophagus ◽  
Esophageal Sphincter ◽  
Secondary Peristalsis

The aim of this study was to determine the role of the superior laryngeal nerve (SLN) in the following esophageal reflexes: esophago-upper esophageal sphincter (UES) contractile reflex (EUCR), esophago-lower esophageal sphincter (LES) relaxation reflex (ELIR), secondary peristalsis, pharyngeal swallowing, and belch. Cats ( N = 43) were decerebrated and instrumented to record EMG of the cricopharyngeus, thyrohyoideus, geniohyoideus, and cricothyroideus; esophageal pressure; and motility of LES. Reflexes were activated by stimulation of the esophagus via slow balloon or rapid air distension at 1 to 16 cm distal to the UES. Slow balloon distension consistently activated EUCR and ELIR from all areas of the esophagus, but the distal esophagus was more sensitive than the proximal esophagus. Transection of SLN or proximal recurrent laryngeal nerves (RLN) blocked EUCR and ELIR generated from the cervical esophagus. Distal RLN transection blocked EUCR from the distal cervical esophagus. Slow distension of all areas of the esophagus except the most proximal few centimeters activated secondary peristalsis, and SLN transection had no effect on secondary peristalsis. Slow distension of all areas of the esophagus inconsistently activated pharyngeal swallows, and SLN transection blocked generation of pharyngeal swallows from all levels of the esophagus. Slow distension of the esophagus inconsistently activated belching, but rapid air distension consistently activated belching from all areas of the esophagus. SLN transection did not block initiation of belch but blocked one aspect of belch, i.e., inhibition of cricopharyngeus EMG. Vagotomy blocked all aspects of belch generated from all areas of esophagus and blocked all responses of all reflexes not blocked by SLN or RLN transection. In conclusion, the SLN mediates all aspects of the pharyngeal swallow, no portion of the secondary peristalsis, and the EUCR and ELIR generated from the proximal esophagus. Considering that SLN is not a motor nerve for any of these reflexes, the role of the SLN in control of these reflexes is sensory in nature only.

scholarly journals Physiology of esophageal sensorimotor malfunctions in neonatal neurological illness

2013 ◽  
Vol 304 (6) ◽  
pp. G574-G582 ◽  
Author(s):  
Sudarshan R. Jadcherla ◽  
Chin Yee Chan ◽  
Rebecca Moore ◽  
Soledad Fernandez ◽  
Reza Shaker
Keyword(s):  
Upper Esophageal Sphincter ◽  
Liquid Volume ◽  
Esophageal Clearance ◽  
Afferent Activation ◽  
Postmenstrual Age ◽  
The Media ◽  
Esophageal Sphincter ◽  
Secondary Peristalsis ◽  
Pharyngeal Swallowing ◽  
And Control

We aimed to define the sensorimotor characteristics of aero-digestive reflexes evoked upon midesophageal provocations in neuropathology infants. Provocative esophageal motility testing was performed in 20 neuropathology infants and 10 controls at 42.3 ± 0.6 and 38.9 ± 0.9 wk postmenstrual age. Data from 1,073 infusions were examined for the sensory thresholds, response frequencies, response magnitude of upper esophageal sphincter (UES) contractile reflexes, lower esophageal sphincter (LES) relaxation reflexes, and peristaltic reflexes using mixed statistical models. Threshold volumes for air and liquid in neuropathology and control infants were similar for all reflexes. Graded air- and liquid volume-dependent UES contractile reflex, LES relaxation reflex, and peristaltic reflex frequency recruitment were present in neuropathology and control subjects for the media ( P < 0.0001) and the reflexes ( P < 0.0001). In neuropathology infants (vs. controls), UES contractile magnitude is higher ( P < 0.0001); LES relaxation reflex occurred earlier ( P = 0.008); LES nadir duration lasted longer ( P = 0.006); secondary peristalsis is the chief method of esophageal clearance ( P < 0.0001); pharyngeal swallows and deglutition apneas are less frequent ( P = 0.001); proximal, midesophageal waveform magnitudes and duration are exaggerated ( P < 0.008). UES contractile reflex was longer with liquid than air in both groups ( P = 0.03). We concluded that 1) perception to midesophageal provocation remains preserved in neuropathology neonates; 2) sustained and exaggerated myogenic response from afferent activation is evident by increased excitatory efferent outputs to the UES and esophageal body and increased inhibitory efferent outputs to the LES; 3) dysfunctional regulation of pharyngeal swallowing and infrequent deglutition responses indicate the possibility of impaired descending modulation and central malfunctions of brainstem and vagal nuclei.

scholarly journals Effects of birth asphyxia on the modulation of pharyngeal provocation-induced adaptive reflexes

2015 ◽  
Vol 309 (8) ◽  
pp. G662-G669 ◽  
Author(s):  
Ish K. Gulati ◽  
Theresa R. Shubert ◽  
Swetha Sitaram ◽  
Lai Wei ◽  
Sudarshan R. Jadcherla
Keyword(s):  
Perinatal Asphyxia ◽  
Birth Asphyxia ◽  
Upper Esophageal Sphincter ◽  
Healthy Controls ◽  
Regulatory Pathways ◽  
Basal Tone ◽  
Sensory Motor ◽  
Postmenstrual Age ◽  
Esophageal Sphincter ◽  
Ischemic Encephalopathy

Perinatal asphyxia and aerodigestive symptoms are troublesome. We tested the hypothesis that pharyngeal provocation alters proximal and distal aerodigestive reflex coordination and kinetics in infants with hypoxic ischemic encephalopathy (HIE), compared with healthy controls. Specifically, we characterized the sensory-motor properties of pharyngeal provocation-induced effects on upper esophageal sphincter (UES) and lower esophageal sphincter (LES) reflexes. Ten orally fed controls (32.0 ± 1.5 wk gestation) and 25 infants with HIE (38.1 ± 0.4 wk gestation) were evaluated at 39.7 ± 0.9 and 41.9 ± 0.6 wk postmenstrual age respectively. Pharyngo-esophageal reflexes evoked upon graded water stimuli were tested using water-perfusion micromanometry methods. Analysis included sensory-motor characteristics of pharyngeal reflexive swallow (PRS), pharyngo-UES-contractile reflex (PUCR), esophageal body-waveform kinetics, and pharyngo-LES-relaxation reflex (PLESRR). For controls vs. infants with HIE, median appearance, pulse, grimace, activity, respiration (APGAR) scores were 6 vs. 1 at 1 min ( P < 0.001) and 8 vs. 3 at 5 min ( P < 0.001). Upon pharyngeal- stimulation, HIE infants (vs. controls) had frequent PUCR ( P = 0.01); increased UES basal tone ( P = 0.03); decreased LES basal tone ( P = 0.002); increased pharyngeal-waveforms per stimulus ( P = 0.03); decreased frequency of LES relaxation ( P = 0.003); and decreased proximal esophageal contractile amplitude ( P = 0.002), with prolonged proximal esophageal contractile duration ( P = 0.008). Increased tonicity and reactivity of the UES and dysregulation of LES may provide the pathophysiological basis for pooling of secretions, improper bolus clearance, and aspiration risk. Deficits in function at the nuclear or supranuclear level involving glossopharyngeal and vagal neural networks and respiratory regulatory pathways involved with aerodigestive protection may be contributory.

Role of pharyngeal propulsion as an indicator for upper esophageal sphincter myotomy

1995 ◽  
Vol 105 (7) ◽  
pp. 723-727 ◽  
Author(s):  
Alain Moine ◽  
Sophie Périé ◽  
Christophe Bokowy ◽  
Bruno Angelard ◽  
Stanislas Chaussade ◽  
...  
Keyword(s):  
Upper Esophageal Sphincter ◽  
Esophageal Sphincter

scholarly journals Esophageal sensation in premature human neonates: temporal relationships and implications of aerodigestive reflexes and electrocortical arousals

2012 ◽  
Vol 302 (1) ◽  
pp. G134-G144 ◽  
Author(s):  
Sudarshan R. Jadcherla ◽  
Vanessa N. Parks ◽  
Juan Peng ◽  
Samuel Dzodzomenyo ◽  
Soledad Fernandez ◽  
...  
Keyword(s):  
Response Duration ◽  
Stimulus Onset ◽  
Upper Esophageal Sphincter ◽  
Sleep State ◽  
Premature Neonates ◽  
Temporal Relationships ◽  
Sensory Motor ◽  
State Changes ◽  
Esophageal Sphincter ◽  
Human Neonates

Electrocortical arousal (ECA) as an effect of visceral provocation or of its temporal relationships with aerodigestive reflexes in premature neonates is not known. We tested the hypothesis that esophageal provocation results in both esophageal reflex responses and ECAs during sleep and that ECAs are dependent on the frequency characteristics of esophageal neuromotor responses. We defined the spatiotemporal relationship of ECAs in relation to 1) spontaneous pharyngoesophageal swallow sequences and gastroesophageal reflux (GER) events and 2) sensory-motor characteristics of esophageal reflexes. Sixteen healthy premature neonates born at 27.9 ± 3.4 wk were tested at 36.8 ± 1.9 wk postmenstrual age. Ninety-five midesophageal and 31 sham stimuli were given in sleep during concurrent manometry and videopolysomnography. With stimulus onset as reference point, we scored the response latency, frequency occurrence and duration of arousals, peristaltic reflex, and upper esophageal sphincter contractile reflex (UESCR). Changes in polysomnography-respiratory patterns and esophageal sensory-motor parameters were scored by blinded observers. Significantly (for each characteristic listed, P < 0.05), swallow sequences were associated with arousals and sleep state changes, and arousals were associated with incomplete peristalsis, response delays to lower esophageal sphincter relaxation, and prolonged esophageal clearance. GER events (73.5%) provoked arousals, and arousals were associated with response delays to peristaltic reflexes or clearance, sleep state modification, and prolonged respiratory arousal. Midesophageal stimuli (54%) provoked arousals and were associated with increased frequency, prolonged latency, prolonged response duration of peristaltic reflexes and UESCR, and increased frequency of sleep state changes and respiratory arousals. In human neonates, ECAs are provoked upon esophageal stimulation; the sensory-motor characteristics of esophageal reflexes are distinct when accompanied by arousals. Aerodigestive homeostasis is defended by multiple tiers of aerodigestive safety mechanisms, and when esophageal reflexes are delayed, cortical hypervigilance (ECAs) occurs.

Functional Diseases of the Esophagus: Role of Endoscopy

1978 ◽  
Vol 87 (4) ◽  
pp. 523-527 ◽  
Author(s):  
Nanjunda Swamy ◽  
John E. Rayl
Keyword(s):  
Significant Risk ◽  
Significant Risk Factor ◽  
Upper Esophageal Sphincter ◽  
Endoscopic Examination ◽  
Phase Iii ◽  
Open Tube ◽  
Risks And Benefits ◽  
Esophageal Sphincter ◽  
Rule Out

The use of endoscopic procedures in the evaluation of primary motor disorders, or functional diseases, of the esophagus is filled with both risks and benefits. Since both flexible and open-tube esophagoscopy carry a significant risk factor, it is necessary to have a clear concept of the indications and value of endoscopy in the management of functional diseases of the esophagus. A review of the literature reveals very little documentation on the value of endoscopy in diagnosing esophageal functional diseases other than Zenker's diverticulum and achalasia. Based on the current literature and the experience of the authors, observations and recommendations concerning the role of endoscopy in functional diseases of the esophagus are presented. These are: 1) In Phase I or upper esophageal sphincter dysfunctions, endoscopy contributes little to their understanding, is difficult to perform, and may be hazardous. In this group, esophagoscopy should be reserved for indications beyond the dysfunction itself. If endoscopy has to be performed, open-tube esophagoscopy should be performed by an experienced endoscopist. 2) In functional diseases of the esophageal body or Phase II dysfunction, endoscopy is frequently valuable. In spastic disorders, it helps to differentiate between primary spasm of neuromuscular origin and spasm secondary to esophagitis or an obstructive process. In scleroderma and pulsion diverticulum, endoscopy helps to identify such unsuspected complications as esophagitis, hiatal hernia, and carcinoma. 3) In Phase III or lower esophageal sphincter dysfunctions, endoscopic examination is essential both to rule out organic lesions that simulate functional disorders, and to determine the presence and extent of esophagitis.

scholarly journals Digestive and respiratory tract motor responses associated with eructation

2013 ◽  
Vol 304 (11) ◽  
pp. G1044-G1053 ◽  
Author(s):  
Ivan M. Lang ◽  
Bidyut K. Medda ◽  
Reza Shaker
Keyword(s):  
Respiratory Tract ◽  
Striated Muscle ◽  
Smooth Muscles ◽  
Upper Esophageal Sphincter ◽  
Gastric Distension ◽  
Thoracic Esophagus ◽  
Striated Muscles ◽  
Motor Responses ◽  
Esophageal Sphincter ◽  
Secondary Peristalsis

We studied the digestive and respiratory tract motor responses in 10 chronically instrumented dogs during eructation activated after feeding. Muscles were recorded from the cervical area, thorax, and abdomen. The striated muscles were recorded using EMG and the smooth muscles using strain gauges. We found eructation in three distinct functional phases that were composed of different sets of motor responses: gas escape, barrier elimination, and gas transport. The gas escape phase, activated by gastric distension, consists of relaxation of the lower esophageal sphincter and diaphragmatic hiatus and contraction of the longitudinal muscle of the thoracic esophagus and rectus abdominis. All these motor events promote gas escape from the stomach. The barrier elimination phase, probably activated by rapid gas distension of the thoracic esophagus, consists of relaxation of the pharyngeal constrictors and excitation of dorsal and ventral upper esophageal sphincter distracting muscles, as well as rapid contraction of the diaphragmatic dome fibers. These motor events allow esophagopharyngeal air movement by promoting retrograde airflow and opening of the upper esophageal sphincter. The transport phase, possibly activated secondary to diaphragmatic contraction, consists of a retrograde contraction of the striated muscle esophagus that transports the air from the thoracic esophagus to the pharynx. We hypothesize that the esophageal reverse peristalsis is mediated by elementary reflexes, rather than a coordinated peristaltic response like secondary peristalsis. The phases of eructation can be activated independently of one another or in a different manner to participate in physiological events other than eructation that cause gastroesophageal or esophagogastric reflux.

scholarly journals Current concepts in the anatomy and origin of pharyngeal diverticula

2009 ◽  
Vol 56 (1) ◽  
pp. 17-24 ◽  
Author(s):  
O.M. Skrobic ◽  
A.P. Simic ◽  
N.S. Radovanovic ◽  
B.V. Spica ◽  
P.M. Pesko
Keyword(s):  
Gastroesophageal Reflux ◽  
Upper Esophageal Sphincter ◽  
Functional Characteristics ◽  
Cricopharyngeal Muscle ◽  
Histopathologic Changes ◽  
Esophageal Sphincter

The role of this paper is to present the current concepts in anatomy and etiopathogenesis of pharyngeal diverticula. Precise anatomical considerations highly emphasizing the weak anatomic areas which predispose the pouch formation are discussed. Focus exposed in details will also be given upon the structural and functional characteristics of the upper esophageal sphincter as well as to its physiological states, architecture and dynamic functions. A brief review of hystorical and current perspectives regarding the origin of pharyngeal diverticula has also been given. Special attention is given to the abnormal cricopharyngeal function in patients with pharyngeal pouches in the terms of altered UES compliance, importance of gastroesophageal reflux and histopathologic changes of cricopharyngeal muscle.

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