scholarly journals A human model of restricted upper esophageal sphincter opening and its pharyngeal and UES deglutitive pressure phenomena

2016 ◽  
Vol 311 (1) ◽  
pp. G84-G90 ◽  
Author(s):  
Hongmei Jiao ◽  
Ling Mei ◽  
Tarun Sharma ◽  
Mark Kern ◽  
Patrick Sanvanson ◽  
...  
Keyword(s):  
Contractile Function ◽  
Cricoid Pressure ◽  
Cricoid Cartilage ◽  
Oropharyngeal Dysphagia ◽  
Upper Esophageal Sphincter ◽  
The Other ◽  
Human Model ◽  
Esophageal Sphincter ◽  
Ues Opening ◽  
High Pressure Zone

Oropharyngeal dysphagia due to upper esophageal sphincter (UES) dysfunction is commonly encountered in the clinical setting. Selective experimental perturbation of various components of the 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. We studied 14 volunteers without any dysphagic symptoms (7 men, 66 ± 11 yr) but with various supraesophageal reflux symptoms. To induce UES restriction, we used a handmade device that with adjustment could selectively apply 0, 20, 30, or 40 mmHg pressure perpendicularly to the cricoid cartilage. Deglutitive pharyngeal and UES pressure phenomena were determined during dry and 5- and 10-ml water swallows × 3 for each of the UES perturbations. External cricoid pressure against the UES resulted in a significant increase in hypopharyngeal intrabolus 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 to 3.1 ± 0.2, 3.5 ± 0.1, and 3.7 ± 0.1 cm for 20, 30, and 40 mmHg cricoid pressure, respectively ( P < 0.05). External cricoid pressure had no significant effect on pharyngeal peristalsis. On the other hand, irrespective of external cricoid pressure deglutitive velopharyngeal contractile integral progressively increased with increased swallowed volumes ( P < 0.05). In conclusion, acute experimental restriction of UES opening by external cricoid pressure manifests the pressure characteristics of increased resistance to UES transsphincteric flow observed clinically without affecting the pharyngeal peristaltic contractile function.

scholarly journals Effects of laryngeal restriction on pharyngeal peristalsis and biomechanics: Clinical implications

2016 ◽  
Vol 310 (11) ◽  
pp. G1036-G1043 ◽  
Author(s):  
Reza Shaker ◽  
Patrick Sanvanson ◽  
Gokulakrishnan Balasubramanian ◽  
Mark Kern ◽  
Ashley Wuerl ◽  
...  
Keyword(s):  
Healthy Subjects ◽  
Contractile Function ◽  
Significant Negative Correlation ◽  
Upper Esophageal Sphincter ◽  
Resistive Load ◽  
Video Recordings ◽  
Pharyngeal Muscles ◽  
Esophageal Sphincter ◽  
Group 2 ◽  
Ues Opening

To date, rehabilitative exercises aimed at strengthening the pharyngeal muscles have not been developed due to the inability to successfully overload and fatigue these muscles during their contraction, a necessary requirement for strength training. The purpose of this study was to test the hypothesis that applying resistance against anterosuperior movement of the hyolaryngeal complex will overload the pharyngeal muscles and by repetitive swallowing will result in their fatigue manifested by a reduction in pharyngeal peristaltic amplitude. Studies were done in two groups. In group 1 studies 15 healthy subjects (age: 42 ± 14 yr, 11 females) were studied to determine whether imposing resistance to swallowing using a handmade device can affect the swallow-induced hyolaryngeal excursion and related upper esophageal sphincter (UES) opening. In group 2, an additional 15 healthy subjects (age 56 ± 25 yr, 7 females) were studied to determine whether imposing resistance to the anterosuperior excursion of the hyolaryngeal complex induces fatigue manifested as reduction in pharyngeal contractile pressure during repeated swallowing. Analysis of the video recordings showed significant decrease in maximum deglutitive superior laryngeal excursion and UES opening diameter ( P < 0.01) due to resistive load. Consecutive swallows against the resistive load showed significant decrease in pharyngeal contractile integral (PhCI) values ( P < 0.01). Correlation analysis showed a significant negative correlation between PhCI and successive swallows, suggesting “fatigue” ( P < 0.001). In conclusion, repeated swallows against a resistive load induced by restricting the anterosuperior excursion of the larynx safely induces fatigue in pharyngeal peristalsis and thus has the potential to strengthen the pharyngeal contractile function.

Opening mechanisms of the human upper esophageal sphincter

1989 ◽  
Vol 257 (5) ◽  
pp. G748-G759 ◽  
Author(s):  
I. J. Cook ◽  
W. J. Dodds ◽  
R. O. Dantas ◽  
B. Massey ◽  
M. K. Kern ◽  
...  
Keyword(s):  
Normal Subjects ◽  
Upper Esophageal Sphincter ◽  
Feedback Mechanism ◽  
Bolus Volume ◽  
Cross Sectional ◽  
Early Entry ◽  
Hyoid Movement ◽  
Esophageal Sphincter ◽  
Ues Opening ◽  
High Pressure Zone

Our goals in this study were to evaluate the mechanisms operative in swallow-associated opening of the upper esophageal sphincter (UES) and to determine the dynamics of fluid flow across the sphincter. For this purpose, we obtained concurrent videofluorographic and manometric studies of 2- to 30-ml barium swallows in 15 normal subjects. We found that the resting UES high-pressure zone corresponded closely with the location of the cricopharyngeus. The findings indicated that manometric UES relaxation and anterior hyoid traction on the larynx invariably preceded UES opening. With graded increases in bolus volume, progressive increases occurred in UES diameter, cross-sectional area, flow duration, and transsphincteric flow rate. Intrabolus pressure upstream to the UES and within the UES at its opening during transsphincteric flow of barium remained within a narrow physiological range of less than 10 mmHg up to a bolus volume of 10 ml. With increases in bolus volume, anterior hyoid movement, UES relaxation, and UES opening occurred sooner in the swallow sequence to accommodate the early entry of large boluses into the pharynx. We conclude that during swallowing 1) normal UES opening involves sphincter relaxation, anterior laryngeal traction, and intrabolus pressure, 2) volume-dependent adaptive changes in UES dimension accommodate large bolus volumes and flow rates with minimal requirement for increases in upstream, or intrasphincteric, intrabolus pressure or UES opening duration, and 3) volume-dependent changes in UES dimensions as well as timing of UES relaxation and opening indicate a sensory feedback mechanism that modulates some components of the swallow response generated by the brain stem swallow centers.

scholarly journals Upper Esophageal Sphincter Dilation for Recalcitrant Dysphagia Secondary to Dermatomyositis

2019 ◽  
Vol 98 (9) ◽  
pp. NP142-NP143
Author(s):  
Mallory J. Raymond ◽  
Nancy L. McColloch ◽  
Jeanne L. Hatcher
Keyword(s):  
Medical Management ◽  
Oropharyngeal Dysphagia ◽  
Autoimmune Disorder ◽  
Upper Esophageal Sphincter ◽  
Esophageal Dysmotility ◽  
Cricopharyngeus Muscle ◽  
Transnasal Esophagoscopy ◽  
Esophageal Sphincter

Dermatomyositis is a rare multisystem autoimmune disorder occasionally accompanied by dysphagia. It is typically treated with immune modulating agents; however, dysphagia is often unresponsive to these. Previous reports have demonstrated the utility of videoflouroscopy and manometry in understanding the etiologies of dysphagia to inform a procedural target, historically the cricopharyngeus muscle. We present a case of dermatomyositis and dysphagia resistant to medical management in a patient found by videoflouroscopy and manometry to have severe oropharyngeal dysphagia, esophageal dysmotility and a cricopharyngeal web. We demonstrate the utility and safety of upper esophageal sphincter dilation by transnasal esophagoscopy even in the setting of multifactorial dysphagia.

Upper esophageal sphincter impedance as a marker of sphincter opening diameter

2012 ◽  
Vol 302 (9) ◽  
pp. G909-G913 ◽  
Author(s):  
Taher I. Omari ◽  
Lara Ferris ◽  
Eddy Dejaeger ◽  
Jan Tack ◽  
Dirk Vanbeckevoort ◽  
...  
Keyword(s):  
Risk Index ◽  
Upper Esophageal Sphincter ◽  
Aim Analysis ◽  
Luminal Diameter ◽  
High Resolution Manometry ◽  
Swallowing Dysfunction ◽  
Pharyngeal Swallow ◽  
Esophageal Sphincter ◽  
Ues Opening ◽  
Swallow Function

The measurement of the physical extent of opening of the upper esophageal sphincter (UES) during bolus swallowing has to date relied on videofluoroscopy. Theoretically luminal impedance measured during bolus flow should be influenced by luminal diameter. In this study, we measured the UES nadir impedance (lowest value of impedance) during bolus swallowing and assessed it as a potential correlate of UES diameter that can be determined nonradiologically. In 40 patients with dysphagia, bolus swallowing of liquids, semisolids, and solids was recorded with manometry, impedance, and videofluoroscopy. During swallows, the UES opening diameter (in the lateral fluoroscopic view) was measured and compared with automated impedance manometry (AIM)-derived swallow function variables and UES nadir impedance as well as high-resolution manometry-derived UES relaxation pressure variables. Of all measured variables, UES nadir impedance was the most strongly correlated with UES opening diameter. Narrower diameter correlated with higher impedance ( r = −0.478, P < 0.001). Patients with <10 mm, 10–14 mm (normal), and ≥15 mm UES diameter had average UES nadir impedances of 498 ± 39 Ohms, 369 ± 31 Ohms, and 293 ± 17 Ohms, respectively (ANOVA P = 0.005). A higher swallow risk index, indicative of poor pharyngeal swallow function, was associated with narrower UES diameter and higher UES nadir impedance during swallowing. In contrast, UES relaxation pressure variables were not significantly altered in relation to UES diameter. We concluded that the UES nadir impedance correlates with opening diameter of the UES during bolus flow. This variable, when combined with other pharyngeal AIM analysis variables, may allow characterization of the pathophysiology of swallowing dysfunction.

scholarly journals Injection of Botulinum Toxin a to Upper Esophageal Sphincter for Oropharyngeal Dysphagia in Two Patients with Inclusion Body Myositis

2004 ◽  
Vol 18 (6) ◽  
pp. 397-399 ◽  
Author(s):  
Louis WC Liu ◽  
Mark Tarnopolsky ◽  
David Armstrong
Keyword(s):  
Botulinum Toxin ◽  
Inclusion Body ◽  
Inclusion Body Myositis ◽  
Botulinum Toxin A ◽  
Oropharyngeal Dysphagia ◽  
Upper Esophageal Sphincter ◽  
Muscle Disease ◽  
Sphincter Pressure ◽  
Toxin A ◽  
Esophageal Sphincter

Inclusion body myositis (IBM) is a progressive degenerative skeletal muscle disease leading to weakening and atrophy of both proximal and distal muscles. Dysphagia is reported in up to 86% of IBM patients. Surgical cricopharyngeal myotomy may be effective for cricopharyngeal dysphagia and there is one published report that botulinum toxin A, injected into the cricopharyngeus muscle using a hypopharyngoscope under general anesthesia, relieved IBM-associated dysphagia. This report presents the first documentation of botulinum toxin A injection into the upper esophageal sphincter using a flexible esophagogastroduodenoscope under conscious sedation, to reduce upper esophageal sphincter pressure and successfully alleviate oropharyngeal dysphagia in two IBM patients.

Change in the Force-Summed Pressure Measurements of the Upper Esophageal Sphincter Prelaryngectomy and Postlaryngectomy

1979 ◽  
Vol 88 (6) ◽  
pp. 804-808 ◽  
Author(s):  
Richard W. Welch ◽  
George A. Gates ◽  
Phillip M. Ricks ◽  
Kenneth F. Luckmann ◽  
Samuel T. Drake
Keyword(s):  
High Pressure ◽  
Rehabilitation Program ◽  
Upper Esophageal Sphincter ◽  
Sphincter Pressure ◽  
Pressure Measurements ◽  
Critical Determinant ◽  
Pressure Zone ◽  
Esophageal Speech ◽  
Esophageal Sphincter ◽  
High Pressure Zone

The pharyngoesophageal high pressure zone (PE-HPZ) was measured prelaryngectomy and postlaryngectomy with a new force-summing probe that accounts for sphincter pressure asymmetry. A total of 31 patients were studied six times each. Postoperatively, pressures dropped from 130 ± 24 mm Hg to 66 ± 9 mm Hg. After a standardized, intensive laryngectomy rehabilitation program, 12 of 19 postoperative patients acquired acceptable esophageal speech and 7 did not. Speakers and nonspeakers were found to have nearly identical PE-HPZ pressures (speakers = 70 ± 10 mm Hg, nonspeakers = 59 ± 18 mm Hg). Differences in sphincter length or relaxation likewise did not discriminate between these two groups. We conclude that PE-HPZ pressure is not a critical determinant of the acquisition of esophageal speech.

scholarly journals Predicting the activation states of the muscles governing upper esophageal sphincter relaxation and opening

2016 ◽  
Vol 310 (6) ◽  
pp. G359-G366 ◽  
Author(s):  
Taher I. Omari ◽  
Corinne A. Jones ◽  
Michael J. Hammer ◽  
Charles Cock ◽  
Philip Dinning ◽  
...  
Keyword(s):  
Sensory Information ◽  
Upper Esophageal Sphincter ◽  
Intraluminal Pressure ◽  
Emg Activity ◽  
Motor Behaviors ◽  
Pharyngeal Pressure ◽  
Intraluminal Impedance ◽  
Esophageal Sphincter ◽  
Ues Opening ◽  
Swallowing Muscles

The swallowing muscles that influence upper esophageal sphincter (UES) opening are centrally controlled and modulated by sensory information. Activation and deactivation of neural inputs to these muscles, including the intrinsic cricopharyngeus (CP) and extrinsic submental (SM) muscles, results in their mechanical activation or deactivation, which changes the diameter of the lumen, alters the intraluminal pressure, and ultimately reduces or promotes flow of content. By measuring the changes in diameter, using intraluminal impedance, and the concurrent changes in intraluminal pressure, it is possible to determine when the muscles are passively or actively relaxing or contracting. From these “mechanical states” of the muscle, the neural inputs driving the specific motor behaviors of the UES can be inferred. In this study we compared predictions of UES mechanical states directly with the activity measured by electromyography (EMG). In eight subjects, pharyngeal pressure and impedance were recorded in parallel with CP- and SM-EMG activity. UES pressure and impedance swallow profiles correlated with the CP-EMG and SM-EMG recordings, respectively. Eight UES muscle states were determined by using the gradient of pressure and impedance with respect to time. Guided by the level and gradient change of EMG activity, mechanical states successfully predicted the activity of the CP muscle and SM muscle independently. Mechanical state predictions revealed patterns consistent with the known neural inputs activating the different muscles during swallowing. Derivation of “activation state” maps may allow better physiological and pathophysiological interpretations of UES function.

Cricoid Cartilage Pressure Decreases Lower Esophageal Sphincter Tone

1997 ◽  
Vol 86 (1) ◽  
pp. 7-9 ◽  
Author(s):  
Jean-Pierre Tournadre ◽  
Dominique Chassard ◽  
Khalid R. Berrada ◽  
Paul Bouletreau
Keyword(s):  
Lower Esophageal Sphincter ◽  
Cricoid Pressure ◽  
Cricoid Cartilage ◽  
Pulmonary Aspiration ◽  
Human Volunteers ◽  
Gastric Pressure ◽  
Manometric Method ◽  
Esophageal Sphincter ◽  
American Society ◽  
American Society Of Anesthesiologists

Background Cricoid cartilage pressure induced to prevent pulmonary aspiration from regurgitation of gastric contents has been recommended, and its efficacy requires a force greater than 40 Newtons. For regurgitation to occur, both an increase in gastric pressure and relaxation of the lower esophageal sphincter (LES) are necessary. However, the effect of cricoid cartilage pressure on the LES is unknown. This study evaluated the effects of cricoid cartilage pressure on LES in human volunteers. Methods Lower esophageal sphincter and esophageal barrier pressures (which equals LES pressure-gastric pressure) were measured using a manometric method in eight unanesthetized volunteers (4 men, 4 women) classified as American Society of Anesthesiologists physical status 1. The force applied to the cricoid cartilage was measured continuously, and LES pressure was recorded at a cricoid force of 20 and 40 Newtons. Results Cricoid pressure decreased LES pressure from 24 +/- 3 mmHg to 15 +/- 4 mmHg at a force of 20 Newtons (P &lt; 0.05) and to 12 +/- 4 mmHg with a force of 40 Newtons (P &lt; 0.01). Conclusions These findings may explain the occurrence of pulmonary aspiration before tracheal intubation despite application of cricoid cartilage pressure.

Influence of normal aging on oral-pharyngeal and upper esophageal sphincter function during swallowing

1995 ◽  
Vol 268 (3) ◽  
pp. G389-G396 ◽  
Author(s):  
D. W. Shaw ◽  
I. J. Cook ◽  
M. Gabb ◽  
R. H. Holloway ◽  
M. E. Simula ◽  
...  
Keyword(s):  
The Elderly ◽  
Normal Aging ◽  
Upper Esophageal Sphincter ◽  
Flow Rates ◽  
Elderly Individuals ◽  
Sphincter Function ◽  
Pharyngeal Swallow ◽  
Esophageal Sphincter ◽  
Ues Opening ◽  
Pharyngeal Swallowing

The influence of aging on oral-pharyngeal swallowing was assessed by simultaneous manometry and videoradiography in 14 nondysphagic elderly individuals (mean age 76 yr) and 11 healthy, young controls (mean age 21 yr). Sphincter opening was diminished significantly in the elderly (P = 0.0001), but trans-sphincteric bolus flow rates were preserved. The increased impedance to trans-sphincteric bolus flow from reduced sphincter opening in the aged was reflected in a significant increase in hypopharyngeal intrabolus pressure (P = 0.003). Oral transit time was significantly prolonged in the aged (P = 0.01). The timing of upper esophageal sphincter (UES) manometric relaxation and of opening was significantly delayed in the aged (P = 0.0001), and this delay was comparable in magnitude to the prolongation in oral transit. Coordination of UES relaxation and opening with midpharyngeal contraction was not significantly affected by age. Deglutitive hyolaryngeal motion was not affected by age but was delayed by a duration equivalent to the prolongation in oral transit. We conclude that normal aging prolongs the oral-pharyngeal swallow that impairs UES opening but does not influence pharyngo-sphincteric coordination.

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