The Physiologic Background of Heartburn, Esophagitis and Cardiospasm

Abstract

From the viewpoint of physiologic organization, swallowing is an act which passes from the sublimely complex to the humbly inchoate. A swallow usually begins as a voluntary phenomenon which sets into motion an integrated sequence of performances and inhibitions delicately controlled by a medullary swallowing center. As the swallow moves through the oropharynx, groups of muscles relax and contract, vital respiratory orifices are occluded, and breathing is temporarily arrested, all within the three-tenths of a second or so it takes the bolus to go from the tip of the tongue to the bottom of the pharynx. The entire sequence of oropharyngeal swallowing is so dependable and so well organized centrally that removal of some of the parts, such as cutting some muscle groups, will not interrupt the integrated synergy performed by the remaining intact musculature.Once the swallow passes the cricopharyngeus muscles separating the pharynx from the esophagus, however, the involuntary and undisciplined motor functions of the gut take over. Although striated muscle continues to extend down the human esophagus for onethird to one-half of its length, the innerva¬ tion is autonomie with regulatory function vested chiefly in a myenteric plexus and the dorsal motor nucleus of the vagus. As compared with the oropharyngeal swallowing function, the organization of esophageal motility thus appears to be at a lower level, with less evidence of central control and greater susceptibility to disorganization by local defects or stimuli. Pharyngoesophageal JunctionThe characteristics of the two major divisions of the swallowing passage are re¬ flected in the degree of success achieved by modern techniques when applied to the study of normal and abnormal oropharyngeal and esophageal function. Modern tools permit more precise, more sensitive, and more rapid measurements of dynamic phenomena and hence have been most helpful in elucidating the rapid, precise, and well-ordered dynam¬ ics of swallowing in the oropharynx. The development of cineradiography, which records x-ray images on movie films, has permitted lucid analysis of the phases of oropharyngeal swallowing, and one of the earlier films on the subject1 shows with exquisite clarity how the piston of the tongue throws the bolus into the pharynx and how the epiglottis flips to cover the laryngeal additus. In addition, however, the film shows that the epiglottic lid may be performing merely an accessory function, for the swal¬ lowing act also pulls up the entire laryngealesophageal column so that the opening of the respiratory passages are tucked securely under the base of the tongue. The movement of the Adam's apple is, after all, not without its purpose.

Treatment of Gastritis With an Antacid‐oxethazaine Mixture

“…However, Atkins and Benedict (4), Palmer (5), and Deutsch and Christian (6) in careful correlative gastroscopic biopsy studies have attempted to classify gastritis according to precise histologic findings. More recent investigations by Ingelfinger (7) and others have called attention to the role of the cardio‐esophageal junction in the causation of the symptoms.…”