Functional anatomy and physiology of the upper esophageal sphincter

Sivarao, Digavalli V.; Goyal, Raj K.

doi:10.1016/s0002-9343(99)00337-x

Cited by 199 publications

(119 citation statements)

References 81 publications

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“…The UES functions as a barrier or gatekeeper, preventing air from entering the digestive tract during breathing and swallowed or refluxed contents from returning into the hypopharynx [1]. UES closure occurs through passive elastic forces and contraction by the posterior muscle complex consisting of cricopharyngeus with contributions from inferior pharyngeal constrictor and proximal esophagus [2][3][4]. In its resting state, the UES remains closed and the CP tonically contracted, with constant brainstem-derived neurogenic input [5].…”

Section: Introductionmentioning

confidence: 99%

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Modulation of Upper Esophageal Sphincter (UES) Relaxation and Opening During Volume Swallowing

et al. 2016

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Background: UES opening occurs following cricopharyngeus deactivation and submental muscle contraction causing hyolaryngeal elevation and UES distraction. During impedance manometry, the inverse of impedance (admittance) can be used to measure bolus presence and infer UES opening. We hypothesized that the temporal relationship between UES relaxation, opening and hyolaryngeal elevation would change with increasing bolus volume. Methods: Simultaneous intramuscular cricopharyngeal (CP) electromyography (EMG), surface submental EMG (SM-EMG) and high-resolution impedance manometry (HRIM)were recorded in eight (aged 27±7 yrs, 5M) healthy volunteers while swallowing 0.9% Saline boluses of 2,5,10 and 20ml. Data were exported and analyzed via Matlab. Statistical analysis comprised of repeated measured one-way ANOVA and Pearson correlation. A P-value of < 0.05 was considered significant Results: Duration of CP deactivation increased at 20ml volume (P < 0.001). UES relaxation and opening increased with increasing bolus volume (P < 0.001), however overall duration of SM activation did not change. As UES opening occurs progressively earlier with increasing volumes, peak SM-EMG activity occurs relatively later (P < 0.001) and shifts from occurring before to following peak UES distention. Conclusions

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Section: Introductionmentioning

confidence: 99%

“…The muscles involved in UES opening are primarily the CP muscle relaxing [2,5] and suprahyoid, (sub-mental, SM) muscles contracting [6][7][8]11]. SM contraction causes sphincter distraction leading to low UES compliance, through which transmitted bolus forces open the sphincter [7].…”

Section: Introductionmentioning

confidence: 99%

Modulation of Upper Esophageal Sphincter (UES) Relaxation and Opening During Volume Swallowing

et al. 2016

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“…If the patient could not use the pharyngeal squeeze maneuver to make sound because of muscle problem, WPC was indicated 2. The ratio of PSR bilaterally (residue area/pyriform sinus area) [17] In VFSS, each patient completed one 3 ml swallow in the lateral view and the value for the following measurement was obtained using Neusoft software (PACS system, China) [22][23][24] [26], or presence of esophageal strictures during FEES [16]. c).…”

Section: Imaging Studies Of Swallow Evaluationmentioning

confidence: 99%

The Swallow Physiology Change of Balloon Dilatation on Pharyngeal Dysphagia

Ding¹

2017

OHNS

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ObjectiveTo evaluate the effect of balloon dilatation in treating pyriform sinus residue caused by various swallow physiology changes from different medical diagnoses. Study designMedical records of 12 in-patients with moderate to severe pyriform sinus residue were retrospectively reviewed. MethodsAll patients were examined with fiberoptic endoscopic evaluation of swallowing and video fluoroscopic swallowing assessment. The diagnoses of the 12 patients included infarction, nasopharyngeal carcinoma post-radiation, oral cancer post partial glossectomy, and motor neuron disease. All 12 patients underwent balloon dilatation.Each session lasted 30 minutes, with eight dilatations per session, three sessions per week for two weeks. ResultsThere was significant reduction in pharyngeal residue pre-versus post-balloon dilatation (p=0.002). There were also significant improvements in cricopharyngeal muscle achalasia (p=0.004) and weak pharyngeal contraction (p=0.008) pre-versus post-treatment. Eight out of the 12 patients made significant progress toward oral feeding (66.67%). ConclusionOur study found cricopharyngeal muscle achalasia and weak pharyngeal contraction were closely related to pyriform sinus residue in pharyngeal dysphagia. Balloon dilatation eliminated cricopharyngeal muscle achalasia and weak pharyngeal contraction and significantly reduced pyriform sinus residue in 8 of the 12 patients. Balloon dilatation seems to have no effect on the reduction of pyriform sinus residue when the cause was either from discoordination of swallowing subsystems in the case of infarction of the left pontocerebellar trigone or loss of large bulk of tongue tissue in the case of cancer treatment.

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“…Ele acontece não apenas no período noturno, mas também durante o dia na posição ereta e de forma intermitente. Nele há acometimento principal do esfíncter esofagiano superior 24 . Sua apresentação, via de regra, faz-se através de sintomas inespecíficos como rouquidão 11,15 , disfagia, sensação de globus, sialorréia, tosse seca 23 , engasgos 21,24,29. Menos da metade dos pacientes podem apresentar queixas gástricas ou esofágicas e a endoscopia digestiva alta pode não revelar sua existência em até 50% dos casos 15,10 .…”

Section: Introductionunclassified

Refluxo laringofaringeano: estudo prospectivo correlacionando achados laringoscópicos precoces com a pHmanometria de 24 horas de 2 canais

Marambaia

Andrade

Varela

et al. 2002

Rev. Bras. Otorrinolaringol.

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Introdução: Manifestações laríngeas do refluxo gastro-esofágico são problemas cada vez mais comuns. Estudos revelam alta associação com sensação de "globus", rouquidão crônica e com tosse crônica. Seu diagnóstico e tratamento diferem da clássica doença do refluxo gastro-esofágico. Os achados à endoscopia laríngea de hiperemia e edema de estruturas glóticas, espessamento do espaço interaritenóideo, granulomas, pólipos, edema de Reinke, estenose subglótica sugerem uma investigação diagnóstica completa através da pHmanometria de 24 horas, exame de maior sensibilidade e especificidade. Objetivos: correlacionar achados clínicos e laringoscópicos precoces sugestivos de refluxo gastro-esofágico com resultados da pHmanometria de 24 horas. Avaliar terapia medicamentosa e modificações dietéticas. Forma de estudo: clínico prospectivo randomizado. Método: 61 pacientes adultos com queixas crônicas: tosse seca, "globus", sialorréia, disfonia, pigarro, halitose e engasgos. Foram excluídos pacientes com outras patologias de vias aéreas. Endoscopia laríngea descartava aqueles que apresentassem lesões laríngeas mais avançadas. Encaminhamento à pHmanometria e iniciado tratamento clínico. Resultados: 83,6% apresentaram refluxo patológico. Sintomas mais freqüentes: disfonia (72,5%), pigarro (60,8%), tosse (29,4%), "globus" (23,5%) e sialorréia (19,6%). Associação de sintomas: dois (67,4%); três (41,2%) e quatro (21,5%). 49 pacientes iniciaram tratamento com omeprazol (20 mg) e dieta: 83,7% cursaram com melhora dos sintomas após 6 meses. Em 95,9% dos pacientes tratados houve melhora laringoscópica. Conclusões: Houve uma correlação importante entre história clínica e endoscopia laríngea com achados à pHmanometria de 24 horas. Outros estudos poderão fortalecer a telescopia laríngea para o diagnóstico do refluxo laringofaríngeo e seu acompanhamento. É necessária abordagem multidisciplinar, além de um aumento do grau de suspeição do especialista.

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Functional anatomy and physiology of the upper esophageal sphincter

Cited by 199 publications

References 81 publications

Modulation of Upper Esophageal Sphincter (UES) Relaxation and Opening During Volume Swallowing

Modulation of Upper Esophageal Sphincter (UES) Relaxation and Opening During Volume Swallowing

The Swallow Physiology Change of Balloon Dilatation on Pharyngeal Dysphagia

Refluxo laringofaringeano: estudo prospectivo correlacionando achados laringoscópicos precoces com a pHmanometria de 24 horas de 2 canais

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