Upper esophageal sphincter opening and modulation during swallowing

Jacob, P.B.; Kahrilas, Peter J.; Logemann, Jerilyn A.; Shah, Vivek P.; T., Ha

doi:10.1016/0016-5085(89)90391-0

Cited by 395 publications

(320 citation statements)

References 11 publications

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“…The algorithm illustrated in Fig. 3 may also explain why we rarely saw negative UES pressures as have been reported in earlier papers (4,6,11,30). The algorithm always isolated the greatest pressure within the spatial domain of the UES, and, although negative pressure might occur at the inferior margin of the sphincter, these were usually negated by more positive proximal pressure.…”

Section: Discussionsupporting

confidence: 78%

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Deglutitive upper esophageal sphincter relaxation: a study of 75 volunteer subjects using solid-state high-resolution manometry

Ghosh¹,

Pandolfino²,

Zhang³

et al. 2006

American Journal of Physiology-Gastrointestinal and Liver Physi

145

130

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. Deglutitive upper esophageal sphincter relaxation: a study of 75 volunteer subjects using solid-state high-resolution manometry. Am J Physiol Gastrointest Liver Physiol 291: G525-G531, 2006. First published April 27, 2006 doi:10.1152/ajpgi.00081.2006.-This study aimed to use a novel high-resolution manometry (HRM) system to establish normative values for deglutitive upper esophageal sphincter (UES) relaxation. Seventy-five asymptomatic controls were studied. A solid-state HRM assembly with 36 circumferential sensors spaced 1 cm apart was positioned to record from the hypopharynx to the stomach. Subjects performed ten 5-ml water swallows and one each of 1-, 10-, and 20-ml volume swallows. Pressure profiles across the UES were analyzed using customized computational algorithms that measured 1) the relaxation interval (RI), 2) the median intrabolus pressure (mIBP) during the RI, and 3) the deglutitive sphincter resistance (DSR) defined as mIBP/RI. The automated analysis succeeded in confirming bolus volume modulation of both the RI and the mIBP with the mean RI ranging from 0.32 to 0.50 s and mIBP ranging from 5.93 to 13.80 mmHg for 1-and 20-ml swallows, respectively. DSR was relatively independent of bolus volume. Peak pharyngeal contraction during the return to the resting state postswallow was almost 300 mmHg, again independent of bolus volume. We performed a detailed analysis of deglutitive UES relaxation with a novel HRM system and customized software. The enhanced spatial resolution of HRM allows for the accurate, automated assessment of UES relaxation and intrabolus pressure characteristics, in both cases confirming the volume-dependent effects and absolute values of these parameters previously demonstrated by detailed analysis of concurrent manometry/fluoroscopy data. Normative values were established to aid in future clinical and investigative studies. deglutitive sphincter resistance; relaxation interval; intrabolus pressure IT IS SOMEWHAT IRONIC that although the upper esophageal sphincter (UES) is the most accessible structure of the esophagus, it is in many ways the least well-understood. Several reflex pathways have been described linking the UES to the esophagus and pharynx (15,20,21,23,24) as have age-related changes in contractile vigor (2,7,22,25,31); however, with the exception of belch-related dysfunction (14, 15), none of these observations have yet been linked to pathological conditions. With respect to pathological conditions, the only clear dysfunction of the UES relates to alterations in its response during swallowing, specifically impaired UES opening during swallowing and impaired relaxation during swallow. Impaired opening, manifest as either stenosis with a cricopharyngeal bar or Zenker's diverticulum (5,8,26), is a recognized cause of dysphagia. Impaired relaxation is probably less common but can be related to neurological dysfunction, best characterized in the case of Parkinson's disease (1, 29). Thus, from a clinical perspective, the functional evaluation of the UES must, first an...

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Section: Discussionsupporting

confidence: 78%

“…Earlier studies have (somewhat subjectively) identified a pressure bump near the offset of relaxation and have measured the magnitude of that bump as intrabolus pressure (6,11). The algorithm illustrated in Fig.…”

Section: Discussionmentioning

confidence: 99%

Deglutitive upper esophageal sphincter relaxation: a study of 75 volunteer subjects using solid-state high-resolution manometry

Ghosh¹,

Pandolfino²,

Zhang³

et al. 2006

American Journal of Physiology-Gastrointestinal and Liver Physi

145

130

View full text Add to dashboard Cite

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“…Sensory coding for volume modulates the efferent neural activation of the swallowing muscles leading to the earlier timing of UES opening [12]. Furthermore, the volume and compressibility of the swallowed bolus can influence the extent of UES opening [7,8,13]. In the current study, we provide further insights into this mechanism via direct electromyographic recordings of the relevant swallowing muscles.…”

Section: Discussionmentioning

confidence: 79%

“…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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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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“…A literatura internacional, desde a década de 80, procurou estudar os mecanismos modulatórios da função da TFE (1,5,6) , através dos inúmeros métodos diagnósticos disponíveis, que incluem a videofluoroscopia, manometria e eletromiografia, entre outros (1,4,5,6) . Conceituou-se, então, que na abertura do ESE ocorre: 1. relaxamento do ESE; 2. tração ântero-superior da laringe, 3. pressão intrabolo e 4. complacência do ESE.…”

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A transição faringoesofágica e seus mistérios

Macedo-Filho¹

2003

Arq. Gastroenterol.

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Upper esophageal sphincter opening and modulation during swallowing

Cited by 395 publications

References 11 publications

Deglutitive upper esophageal sphincter relaxation: a study of 75 volunteer subjects using solid-state high-resolution manometry

Deglutitive upper esophageal sphincter relaxation: a study of 75 volunteer subjects using solid-state high-resolution manometry

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

A transição faringoesofágica e seus mistérios

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