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

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 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.

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.

The upper esophageal sphincter in the cat: the role of central innervation assessed by transient vagal blockade

1987 ◽  
Vol 65 (1) ◽  
pp. 96-99 ◽  
Author(s):  
R. P. E. Reynolds ◽  
G. W. Effer ◽  
M. P. Bendeck
Keyword(s):  
Upper Esophageal Sphincter ◽  
Vagal Nerve ◽  
Sphincter Pressure ◽  
Neural Pathways ◽  
Cervical Nerve ◽  
Nerve Blockade ◽  
Acid Perfusion ◽  
Balloon Distention ◽  
Esophageal Sphincter

Studies were performed on four cats to assess the role of extrinsic innervation via the cervical nerve trunks in the control of upper esophageal sphincter function. Transient vagal nerve blockade was accomplished by cooling the cervical vagosympathetic nerve trunks previously isolated in skin loops on each side of the neck. Upper esophageal sphincter pressure was measured using a multilumen oval manometry tube and a rapid pull-through technique. The upper esophageal sphincter response to cervical intraesophageal balloon distention and acid perfusion was assessed. The feline upper esophageal sphincter has a distinct asymmetric pressure profile, whereby anterior pressure > posterior pressure > left pressure > right pressure. Bilateral vagal nerve blockade lowered the mean upper esophageal sphincter pressure from 18.5 ± 1.5 to 12.0 ± 2.8 mmHg (1 mmHg = 133.3 Pa) (p < 0.001), with a significant reduction in pressure in all four quadrants. Intraesophageal balloon distention and acid perfusion both produced a significant increase in upper esophageal sphincter pressure. Bilateral vagal nerve blockade completely abolished the response of the upper esophageal sphincter to balloon distention and acid perfusion. We conclude that (i) normal upper esophageal sphincter tone in the cat is partially mediated by excitatory neural input via the cervical nerve trunks, presumably via the recurrent laryngeal nerves; and (ii) cervical intraesophageal balloon distention and acid perfusion produce reflex contraction of the upper esophageal sphincter, which is dependent on neural pathways via the cervical vagal nerve trunks, but the relative contribution of afferent and efferent pathways remains unknown.

scholarly journals Role of Laryngeal Movement and Effect of Aging on Swallowing Pressure in the Pharynx and Upper Esophageal Sphincter

2000 ◽  
Vol 110 (3) ◽  
pp. 434-439 ◽  
Author(s):  
Masato Yokoyama ◽  
Natsuhiko Mitomi ◽  
Katsuhiko Tetsuka ◽  
Niro Tayama ◽  
Seiji Niimi
Keyword(s):  
Upper Esophageal Sphincter ◽  
Esophageal Sphincter ◽  
Swallowing Pressure

scholarly journals The Effect of Bolus Volume on Hyoid Kinematics in Healthy Swallowing

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Ahmed Nagy ◽  
Sonja M. Molfenter ◽  
Melanie Péladeau-Pigeon ◽  
Shauna Stokely ◽  
Catriona M. Steele
Keyword(s):  
Peak Velocity ◽  
Upper Esophageal Sphincter ◽  
Healthy Population ◽  
Bolus Volume ◽  
Velocity Increase ◽  
Movement Distance ◽  
Hyoid Movement ◽  
Laryngeal Vestibule ◽  
Esophageal Sphincter ◽  
Liquid Bolus

Hyoid movement in swallowing is biomechanically linked to closure of the laryngeal vestibule for airway protection and to opening of the upper esophageal sphincter. Studies suggest that the range of hyoid movement is highly variable in the healthy population. However, other aspects of hyoid movement such as velocity remain relatively unexplored. In this study, we analyze data from a sample of 20 healthy young participants (10 male) to determine whether hyoid movement distance, duration, velocity, and peak velocity vary systematically with increases in thin liquid bolus volume from 5 to 20 mL. The temporal correspondence between peak hyoid velocity and laryngeal vestibule closure was also examined. The results show that maximum hyoid position and peak velocity increase significantly for 20 mL bolus volumes compared to smaller volumes, and that the timing of peak velocity is closely linked to achieving laryngeal vestibule closure. This suggests that generating hyoid movements with increased power is a strategy for handling larger volumes.

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