A Human Model of Restricted Upper Esophageal Sphincter Opening and Its Pharyngeal and UES Deglutitive Pressure Phenomena.

A Human Model of Restricted Upper Esophageal Sphincter Opening and Its Pharyngeal and UES Deglutitive Pressure Phenomena.

Am J Physiol Gastrointest Liver Physiol. 2016 May 19;:ajpgi.00145.2016

Authors: Jiao H, Mei L, Sharma T, Kern MK, Sanvanson P, Shaker R

Abstract
BACKGROUND: Oropharyngeal dysphagia due to UES dysfunction is commonly encountered in the clinical setting. Selective experimental perturbation of various components of deglutitive apparatus can provide an opportunity to improve our understanding of the swallowing physiology and pathophysiology. The aim is to characterize the pharyngeal and UES deglutitive pressure phenomena in an experimentally induced restriction of UES opening in humans.
METHODS: We studied 14 volunteers without any dysphagic symptoms (7 male, 66±11 years) but with various supraesophageal reflux symptoms. To induce UES restriction, we used a handmade device that with adjustment could selectively apply 0, 20, 30, 40 mmHg pressure perpendicularly to the cricoid cartilage. Deglutitive pharyngeal and UES pressure phenomena were determined during dry, 5 and 10ml water swallows x 3 for each of the UES perturbations.
RESULTS: Increased restrictive pressure against UES resulted in a significant increase in hypopharyngeal intra-bolus pressure and UES nadir deglutitive relaxation pressure for all tested swallowed volumes (p<0.05). Application of external cricoid pressure increased the length of the UES high pressure zone from 2.5± 0.2 cm to 3.1± 0.2, 3.5± 0.1 and 3.7± 0.1 cm for 20, 30, 40mmHg cricoid pressure, respectively (p<0.05). External cricoid pressure had no significant effect on pharyngeal peristalsis. On the other hand, irrespective to external cricoid pressure deglutitive velopharyngeal contractile integral progressively increased with increased swallowed volumes (p<0.05).
CONCLUSION: Acute experimental restriction of UES opening by external cricoid pressure manifests the pressure characteristics of increased resistance to UES trans-sphincteric flow observed clinically without affecting the pharyngeal peristaltic contractile function.

PMID: 27198193 [PubMed - as supplied by publisher]

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