Esophago-Glottal Closure Reflex in Human Infants: A Novel Reflex Elicited With Concurrent Manometry and Ultrasonography

Jadcherla, Sudarshan R.; Gupta, Alankar; Coley, Brian D.; Fernández, Soledad; Shaker, Reza

doi:10.1111/j.1572-0241.2007.01401.x

Cited by 68 publications

(79 citation statements)

References 26 publications

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“…Pulmonary aspiration is a potential cause of mortality and/or morbidity in high-risk infants. Laryngeal adduction in response to pharyngeal or esophageal stimulation results in closure of the glottis and protects against airway aspiration; these reflexes are called the pharyngo-glottal closure reflex and esophago-glottal closure reflex (16,19). These vigilant reflexes are usually associated with pharyngeal reflexive swallows and deglutition response or secondary peristalsis.…”

Section: Physiologic Considerationsmentioning

confidence: 99%

Dysphagia in the high-risk infant: potential factors and mechanisms

Jadcherla

2016

The American Journal of Clinical Nutrition

117

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Neonatal dysphagia, or abnormalities of swallowing, represent a major global problem, and consequences of dysfunctional feeding patterns carry over into infancy and toddler age groups. Growth, development, and independent feeding skills are all delayed among high-risk infants. Such a group comprises premature birth, low-birth-weight, congenital anomalies, perinatal asphyxia, postsurgical, and sepsis categories. The conflict between pathophysiologic and pragmatic feeding strategies remains a major conundrum and is largely due to a lack of validated diagnostic approaches amid heterogeneity of the patient phenotype. Thus, well-tested feeding management strategies that can be generalizable are lacking. Furthermore, the aerodigestive symptoms and signs, potential risk factors, and contributory etiologies remain nonspecific. This article presents mechanistic evidence related to the pathophysiologic basis of neonatal dysphagia as well as potential opportunities to improve feeding abilities and long-term development.Am J Clin Nutr 2016;103(Suppl):622S-8S.

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Section: Physiologic Considerationsmentioning

confidence: 99%

Dysphagia in the high-risk infant: potential factors and mechanisms

Jadcherla

2016

The American Journal of Clinical Nutrition

117

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“…Supranuclear pathways relay to the thalamus, basal ganglia, and cerebral cortex (pre-and postcentral gyrus), which participate in further modulation of perception, volitional, and central regulatory swallowing and feeding behaviors. We have previously shown in healthy premature infants that pharyngeal stimulation activates several airway-protective reflexes that modulate safe swallowing sequences along with respiratory adaptation (11)(12)(13)(14)17). These adaptive responses include pharyngeal reflexive swallowing (PRS), pharyngo-upper esophageal sphincter contractile reflex (PUCR), pharyngo-lower esophageal sphincter relaxation reflex (PLESRR), deglutition apnea, and adaptive respiratory changes (11)(12)(13)17).…”

mentioning

confidence: 99%

Effect of nasal noninvasive respiratory support methods on pharyngeal provocation-induced aerodigestive reflexes in infants

Jadcherla

Hasenstab

Sitaram

et al. 2016

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…The earliest lung defense mechanisms begins with the fetal glottic closure reflex, a protective strategy for preventing aspiration of amniotic fluid into the tracheobronchial tree and lungs during intrauterine life [16]. The human fetus regularly swallows amniotic fluid containing fetal lung fluid, fetal urine, debris from skin cells and particulate matter during intrauterine life [93,94]. By full-term gestation at 37 weeks, the fetus is capable of swallowing and circulating roughly 500 mL of amniotic fluid daily [69].…”

Section: Discussionmentioning

confidence: 99%

Vocal Cord Dysfunction after an Inhalation Exposure

Brooks¹

2017

J Allergy Ther

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The manuscript embodies case material and the author's extensive personal experience to address a perceived or actual airborne exposure when incorrectly judged as due to intrathoracic/lung damage when in reality the outcome is the more innocuous extrathoracic/upper airway's vocal cord dysfunction (VCD). Because of the conviction of possible lung injury, the individual applies the fetal protective glottic closure reflex to counteract an odorant cue instigating acute VCD. Breathing against an obstructed glottis as well as hyperventilation from anxiety, panic and/or fear of personal harm worsens the laryngeal spasm. Spirometer shows flattening of the inspiratory loop of the flow-volume curve and endoscopy, while not done, would reveal adduction of the anterior two-thirds of the vocal cords with posterior chinking creating a diamond shape configuration. Successful therapy and management of VCD requires a speech therapy approach rather than physician prescribed medications.

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Esophago-Glottal Closure Reflex in Human Infants: A Novel Reflex Elicited With Concurrent Manometry and Ultrasonography

Abstract: BACKGROUND AND AIMS-Our aims were to identify and characterize the glottal response to esophageal mechanostimulation in human infants. We tested the hypotheses that glottal response is related to the type of esophageal peristaltic response, stimulus volume, and respiratory phase.

Cited by 68 publications

References 26 publications

Dysphagia in the high-risk infant: potential factors and mechanisms

Dysphagia in the high-risk infant: potential factors and mechanisms

Effect of nasal noninvasive respiratory support methods on pharyngeal provocation-induced aerodigestive reflexes in infants

Vocal Cord Dysfunction after an Inhalation Exposure

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