Function of upper esophageal sphincter during swallowing: the grabbing effect

1997 ◽  
Vol 272 (5) ◽  
pp. G1057-G1063
Author(s):  
P. Pouderoux ◽  
P. J. Kahrilas
Keyword(s):  
Healthy Volunteers ◽  
Axial Force ◽  
Traction Force ◽  
Force Transducer ◽  
Upper Esophageal Sphincter ◽  
Cervical Esophagus ◽  
Sphere Diameter ◽  
Laryngeal Inlet ◽  
Pharyngeal Swallow ◽  
Esophageal Sphincter

This study investigated deglutitive axial force developed within the pharynx, upper esophageal sphincter (UES), and cervical esophagus. Position and deglutitive excursion of the UES were determined using combined manometry and videofluoroscopy in eight healthy volunteers. Deglutitive clearing force was quantified with a force transducer to which nylon balls of 6- or 8-mm diameter were tethered and positioned within the oropharynx, hypopharynx, UES, and cervical esophagus. Axial force recordings were synchronized with videofluoroscopic imaging. Clearing force was dependent on both sphere diameter (P < 0.05) and location, with greater force exhibited in the hypopharynx and UES compared with the oropharynx and esophagus (P < 0.05). Within the UES, the onset of traction force coincided with passage of the pharyngeal clearing wave but persisted well beyond this. On videofluoroscopy, the persistent force was associated with the aboral motion of the ball caught within the UES. Force abated with gradual slippage of the UES around the ball. The force attributable to the combination of UES contraction and laryngeal descent was named the grabbing effect. The grabbing effect functions to transfer luminal contents distal to the laryngeal inlet at the end of the pharyngeal swallow, presumably acting to prevent regurgitation and/or aspiration of swallowed material.

Influence of mucosal receptors on deglutitive regulation of pharyngeal and upper esophageal sphincter function

1994 ◽  
Vol 267 (4) ◽  
pp. G644-G649 ◽  
Author(s):  
G. N. Ali ◽  
T. M. Laundl ◽  
K. L. Wallace ◽  
D. W. Shaw ◽  
D. J. Decarle ◽  
...  
Keyword(s):  
Sensory Input ◽  
Upper Esophageal Sphincter ◽  
Sensory Receptors ◽  
Potential Influence ◽  
Sphincter Function ◽  
Temporal Regulation ◽  
Wave Characteristics ◽  
Pharyngeal Swallow ◽  
Esophageal Sphincter ◽  
Contraction Wave

The potential influence of mucosal sensory receptors on the regulation of oral-pharyngeal swallow events was studied in 15 healthy volunteers using simultaneous videoradiography and manometry. We determined the effects of selective pharyngeal and oral plus pharyngeal anesthesia on the following temporal and manometric measures in response to liquid and viscous swallows: regional transit and clearance times; motion of hyoid and larynx; upper esophageal sphincter relaxation, opening, and closure; and pharyngeal contraction wave characteristics. Under the influence of mucosal anesthesia no subjects demonstrated aspiration during deglutition. Neither regional transit and clearance times nor pharyngosphincteric coordination was influenced significantly by pharyngeal mucosal anesthesia or oral plus pharyngeal anesthesia. Although midpharyngeal and distal pharyngeal contraction amplitudes were not influenced by mucosal anesthesia, midpharyngeal contraction wave duration was reduced significantly by both pharyngeal (P = 0.02) and oral plus pharyngeal anesthesia (P = 0.0005). We conclude that 1) neither elicitation of the pharyngeal swallow response nor temporal regulation among swallow events is dependent on mucosal sensory receptors and 2) duration of the pharyngeal contraction is influenced by sensory input from the oral-pharyngeal mucosa.

Upper esophageal sphincter impedance as a marker of sphincter opening diameter

2012 ◽  
Vol 302 (9) ◽  
pp. G909-G913 ◽  
Author(s):  
Taher I. Omari ◽  
Lara Ferris ◽  
Eddy Dejaeger ◽  
Jan Tack ◽  
Dirk Vanbeckevoort ◽  
...  
Keyword(s):  
Risk Index ◽  
Upper Esophageal Sphincter ◽  
Aim Analysis ◽  
Luminal Diameter ◽  
High Resolution Manometry ◽  
Swallowing Dysfunction ◽  
Pharyngeal Swallow ◽  
Esophageal Sphincter ◽  
Ues Opening ◽  
Swallow Function

The measurement of the physical extent of opening of the upper esophageal sphincter (UES) during bolus swallowing has to date relied on videofluoroscopy. Theoretically luminal impedance measured during bolus flow should be influenced by luminal diameter. In this study, we measured the UES nadir impedance (lowest value of impedance) during bolus swallowing and assessed it as a potential correlate of UES diameter that can be determined nonradiologically. In 40 patients with dysphagia, bolus swallowing of liquids, semisolids, and solids was recorded with manometry, impedance, and videofluoroscopy. During swallows, the UES opening diameter (in the lateral fluoroscopic view) was measured and compared with automated impedance manometry (AIM)-derived swallow function variables and UES nadir impedance as well as high-resolution manometry-derived UES relaxation pressure variables. Of all measured variables, UES nadir impedance was the most strongly correlated with UES opening diameter. Narrower diameter correlated with higher impedance ( r = −0.478, P < 0.001). Patients with <10 mm, 10–14 mm (normal), and ≥15 mm UES diameter had average UES nadir impedances of 498 ± 39 Ohms, 369 ± 31 Ohms, and 293 ± 17 Ohms, respectively (ANOVA P = 0.005). A higher swallow risk index, indicative of poor pharyngeal swallow function, was associated with narrower UES diameter and higher UES nadir impedance during swallowing. In contrast, UES relaxation pressure variables were not significantly altered in relation to UES diameter. We concluded that the UES nadir impedance correlates with opening diameter of the UES during bolus flow. This variable, when combined with other pharyngeal AIM analysis variables, may allow characterization of the pathophysiology of swallowing dysfunction.

S118 – Study of Pharyngeal Swallowing by High-resolution Manometry

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P116-P117
Author(s):  
Kenji Takasaki ◽  
Umeki Hiroshi ◽  
Kaori Enatsu ◽  
Fujinobu Tanaka ◽  
Hidetaka Kumagami ◽  
...  
Keyword(s):  
High Resolution ◽  
Normal Values ◽  
Upper Esophageal Sphincter ◽  
Cervical Esophagus ◽  
High Resolution Manometry ◽  
Maximum Value ◽  
Physiological Information ◽  
Asymptomatic Adult ◽  
Esophageal Sphincter ◽  
Pharyngeal Swallowing

Objectives This study aimed to demonstrate the feasibility of a novel high-resolution manometry (HRM) system, and to establish normal values of swallowing pressures along the velopharynx and upper esophagus. Methods 33 asymptomatic adult Japanese controls were studied. A solid-state HRM assembly with 36 circumferential sensors spaced 1 cm apart was positioned to record pressures during swallowing from the velopharynx to the upper esophagus. The maximum values of the swallowing (dry and 5 ml of water) pressures at velo, meso-hypopharynx, and at the upper esophageal sphincter (UES) were measured. The resting UES pressure, the length of the part in the cervical esophagus showing the resting UES pressure, and the distance from the nostril to the above-mentioned points of pressure were also measured. Results The maximum value of dry and water swallowing pressures at the velopharynx, meso-hypopharynx and UES, and the distances from the nasal vestibulum to each point were 132.3±61.3 (mmHg, mean ± standard deviation), and 146.5±77.5, 171.6±52.0, and 176.3±74.4, 163.5±70.6, and 239.3±80.1, and 9.8±1.2 (cm), and 9.8±1.3, 13.6±1.6, and 13.7±1.5, 17.0±1.9 and 17.1±1.6, respectively. The maximum value of the resting USE pressure, the length of the part in the cervical esophagus showing the resting USE pressure, and the distance from the nostril to the mid-point of the length of the resting UES pressure were 66.6±28.1 mmHg, 3.8±0.7 cm, and 18.2±1.6 cm, respectively. Conclusions The present study provides anatomical and physiological information about normal swallowing along the velopharynx and upper esophagus, which will be an aid to future clinical and investigative studies.

scholarly journals Pharyngeal airway protective reflexes are triggered before the maximum volume of fluid that the hypopharynx can safely hold is exceeded

2011 ◽  
Vol 301 (2) ◽  
pp. G197-G202 ◽  
Author(s):  
Kulwinder Dua ◽  
Sri Naveen Surapaneni ◽  
Shiko Kuribayashi ◽  
Muhammad Hafeezullah ◽  
Reza Shaker
Keyword(s):  
Supine Position ◽  
Upper Esophageal Sphincter ◽  
Maximum Volume ◽  
Maximum Capacity ◽  
Pharyngeal Airway ◽  
Pharyngeal Swallow ◽  
Threshold Volume ◽  
Esophageal Sphincter ◽  
The Relationship ◽  
Superior Margin

Aerodigestive reflexes triggered by pharyngeal stimulation can protect the airways by clearing fluid from the pharynx. The objective of this study was to determine the relationship between the maximum capacity of fluid that can safely dwell in the hypopharynx [hypopharyngeal safe volume (HPSV)] before spilling into the larynx and the threshold volumes required to trigger pharyngoglottal closure reflex (PGCR), pharyngo-upper esophageal sphincter contractile reflex (PUCR), and reflexive pharyngeal swallow (RPS). Twenty-five healthy volunteers (mean age 24 yr, 8 males) were studied in the semi-inclined supine position. PGCR, PUCR, and RPS were elicited using techniques of concurrent upper esophageal sphincter manometry and pharyngo-laryngoscopy. The hypopharynx was then anesthetized to abolish RPS. HPSV was determined by infusing water in the pharynx, and perfusion was stopped when the infusate reached the superior margin of the interarytenoid fold. The threshold volumes for triggering PGCR, PUCR, and RPS by slow and rapid injections before pharyngeal anesthesia were 0.18 ± 0.02 and 0.09 ± 0.02 ml; 0.20 ± 0.020 and 0.13 ± 0.04 ml; and 0.61 ± 0.04 and 0.4 ± 0.06 ml, respectively. All of the above volumes were significantly smaller than the HPSV (0.70 ± 0.06 ml, P < 0.01) except for the threshold volume to elicit RPS during slow perfusion, which was not significantly different ( P = 0.23). We conclude that pharyngeal aerodigestive reflexes are triggered by both slow and rapid pharyngeal perfusion of water at significantly smaller volumes than the maximum capacity of the hypopharynx to safely hold contents without spilling into the airway. These reflexes thereby aid in prevention of aspiration.

Influence of normal aging on oral-pharyngeal and upper esophageal sphincter function during swallowing

1995 ◽  
Vol 268 (3) ◽  
pp. G389-G396 ◽  
Author(s):  
D. W. Shaw ◽  
I. J. Cook ◽  
M. Gabb ◽  
R. H. Holloway ◽  
M. E. Simula ◽  
...  
Keyword(s):  
The Elderly ◽  
Normal Aging ◽  
Upper Esophageal Sphincter ◽  
Flow Rates ◽  
Elderly Individuals ◽  
Sphincter Function ◽  
Pharyngeal Swallow ◽  
Esophageal Sphincter ◽  
Ues Opening ◽  
Pharyngeal Swallowing

The influence of aging on oral-pharyngeal swallowing was assessed by simultaneous manometry and videoradiography in 14 nondysphagic elderly individuals (mean age 76 yr) and 11 healthy, young controls (mean age 21 yr). Sphincter opening was diminished significantly in the elderly (P = 0.0001), but trans-sphincteric bolus flow rates were preserved. The increased impedance to trans-sphincteric bolus flow from reduced sphincter opening in the aged was reflected in a significant increase in hypopharyngeal intrabolus pressure (P = 0.003). Oral transit time was significantly prolonged in the aged (P = 0.01). The timing of upper esophageal sphincter (UES) manometric relaxation and of opening was significantly delayed in the aged (P = 0.0001), and this delay was comparable in magnitude to the prolongation in oral transit. Coordination of UES relaxation and opening with midpharyngeal contraction was not significantly affected by age. Deglutitive hyolaryngeal motion was not affected by age but was delayed by a duration equivalent to the prolongation in oral transit. We conclude that normal aging prolongs the oral-pharyngeal swallow that impairs UES opening but does not influence pharyngo-sphincteric coordination.

Biomechanics of failed deglutitive upper esophageal sphincter relaxation in neurogenic dysphagia

2002 ◽  
Vol 283 (1) ◽  
pp. G16-G26 ◽  
Author(s):  
Rohan B. H. Williams ◽  
Karen L. Wallace ◽  
Galib N. Ali ◽  
Ian J. Cook
Keyword(s):  
Biomechanical Properties ◽  
Upper Esophageal Sphincter ◽  
Zenker’S Diverticulum ◽  
Bolus Volume ◽  
Neurogenic Dysphagia ◽  
Zenker's Diverticulum ◽  
Pharyngeal Swallow ◽  
Extrapyramidal Disease ◽  
Esophageal Sphincter ◽  
Ues Opening

Our aims were to examine the etiology and biomechanical properties of the nonrelaxing upper esophageal sphincter (UES) and the relationship between UES opening and failed relaxation. We examined the relationships among swallowed bolus volume, intrabolus pressure, sagittal UES diameter, the pharyngeal swallow response, and geniohyoid shortening in 18 patients with failed UES relaxation, 23 healthy aged controls, and 15 with Zenker's diverticulum. Etiology of failed UES relaxation was 56% medullary disease, 33% Parkinson's or extrapyramidal disease; and 11% idiopathic. Extent of UES opening ranged from absent to normal and correlated with preservation of the pharyngeal swallow response ( P = 0.012) and geniohyoid shortening ( P = 0.046). Intrabolus pressure was significantly greater compared with aged controls ( P < 0.001) or Zenker's diverticulum ( P < 0.001). The bolus volume-dependent increase in intrabolus pressure evident in controls was not observed in failed UES relaxation. The nonrelaxing UES therefore displays a constant loss of sphincter compliance throughout the full, and potentially normal, range of expansion during opening. Adequacy of UES opening is influenced by the degree of preservation of the pharyngeal swallow response and hyolaryngeal traction. In contrast, the stenotic UES displays a static loss of compliance, only apparent once the limit of sphincter expansion is reached.

Cricopharyngeal Dysfunction

1992 ◽  
Vol 106 (2) ◽  
pp. 163-168 ◽  
Author(s):  
Janet A. Wilson ◽  
Anne Pryde ◽  
Paul L. Allan ◽  
Arnold G.D. Maran
Keyword(s):  
Healthy Volunteers ◽  
Upper Esophageal Sphincter ◽  
Control Group ◽  
Muscular Hypertrophy ◽  
Cricopharyngeal Myotomy ◽  
Esophageal Sphincter ◽  
Cricopharyngeal Dysfunction ◽  
Ues Opening ◽  
Dysphagic Patients ◽  
Radiologic Evidence

The aim of the study was to determine the manometric patterns in dysphagic patients with radiologic evidence of upper esophageal sphincter (UES) dysfunction. Nineteen patients with radiographic abnormalities of the UES underwent measurement of several parameters of UES tonic pressure and pharyngoesophageal water swallow dynamics. At least two UES tonic pressures were elevated in six subjects, compared with a control group of 67 healthy volunteers. No patient had UES achalasia. The cricopharyngeal impression in the remaining patients may represent muscular hypertrophy or deficiency of UES opening, despite manometric relaxation, but its relationship to the patient's symptoms remains unknown. Cricopharyngeal myotomy appears to be a reasonable treatment for patients with manometric UES hypertonicity.

Mechanism and timing of nasopharyngeal closure during swallowing and belching

1995 ◽  
Vol 268 (6) ◽  
pp. G1037-G1042 ◽  
Author(s):  
K. Dua ◽  
R. Shaker ◽  
J. Ren ◽  
R. Arndorfer ◽  
C. Hofmann
Keyword(s):  
Healthy Volunteers ◽  
Soft Palate ◽  
Temporal Relationship ◽  
Upper Esophageal Sphincter ◽  
Pharyngeal Muscle ◽  
Constrictor Muscle ◽  
Complete Closure ◽  
Esophageal Sphincter ◽  
Manometric Technique ◽  
Technique Analysis

The mechanism(s) of nasopharyngeal closure (NPC) and its temporal relationship with other biomechanical events during swallowing and belching were studied in seven healthy volunteers, aged 26-39 yr, by concurrent videoendoscopic, videofluoroscopic, and manometric technique. Analysis of the videoendoscopic recordings showed that deglutitive NPC consisted of elevation of the soft palate and adduction of the superior pharyngeal constrictor muscle. Videofluoroscopy identified only the palatal elevation clearly. During belching, however, only palatal elevation occurred. Deglutitive NPC ranged between 0.73 and 0.94 s (0.8 +/- 0.04 SE), with a tendency to be longer with larger swallowed volumes. Onset of NPC was identified earlier endoscopically than as seen fluoroscopically. Complete NPC preceded the arrival of barium bolus into the pharynx, and this pattern was seen for all volumes tested. Manometric onset of upper esophageal sphincter (UES) relaxation was seen before the onset of NPC, but the physical opening of the UES as seen fluoroscopically occurred after complete closure of the nasopharynx. We conclude the following: 1) The mechanism of NPC during swallowing and belching is different. During swallowing, NPC has two tiers of closure, palatal elevation and superior pharyngeal muscle adduction; during belching only palatal elevation occurs. 2) NPC is tightly coordinated with other biomechanical events during swallowing and belching.

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