Gastroenterology

Gastroenterology

Volume 95, Issue 1, July 1988, Pages 52-62
Gastroenterology

Upper esophageal sphincter function during deglutition

https://doi.org/10.1016/0016-5085(88)90290-9Get rights and content

Abstract

Upper esophageal sphincter function was investigated during swallows of graded volumes in 8 normal volunteers. Concurrent recordings of videofluoroscopic and manometric studies were obtained and correlated with each other by means of a videotimer. Maximal upper esophageal sphincter (UES) pressure was typically located 1.5 cm distal to the air-tissue interface between the hypopharynx and the proximal margin of the sphincter. The region in which UES pressure was ≥ 50% maximal averaged 1.0 cm in length. Thus, the physiologic high-pressure zone of the UES corresponds in size and location to that of the cricopharyngeus muscle. Fluoroscopic analysis of sphincter movement indicated that the sphincter high-pressure zone moved 2.0–2.5 cm orally during swallowing and that the magnitude of the orad movement was directly related to the volume of barium swallowed. The maximal anterior-posterior diameter of sphincter opening during a swallow ranged from 0.9 to 1.5 cm and was also directly related to the volume swallowed. The intervals of UES opening and relaxation increased significantly with increasing bolus volume; the duration of UES relaxation ranged from a mean of 0.37 s for dry swallows to 0.65 s for 20-ml swallows. Thus, the dynamics of UES function during deglutition are dependent upon the volume of the swallowed bolus. Larger bolus volumes are accommodated by both an increased diameter of sphincter opening and by prolongation of the interval of sphincter relaxation. Analysis of the timing of other reference points within the pharyngeal swallow sequence indicated that as the manometric interval of UES relaxation increased, the period of laryngeal elevation was prolonged, the UES relaxed earlier and contracted later, and the interval between the onset of laryngeal elevation and hypopharyngeal contraction increased.

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    Citation Excerpt :

    This high-pressure zone is responsible for the physiological functions of the UES. The preponderance of evidence suggests that the primary muscle responsible for the high-pressure zone of the UES is the cricopharyngeus muscle (Asoh and Goyal, 1978; Kahrilas et al., 1988; Lang et al., 1991). Electrical activity of the CP muscle (EAcp) has been repeatedly reported in phase with respiration in several studies in both adult human and animal subjects (Levitt et al., 1965; Kahrilas et al., 1987; Jacob et al., 1990; Lang and Shaker, 1997; Ertekin and Aydogdu, 2002; Jones et al., 2014).

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This work was supported by a fellowship from The Schweppe Foundation (P.J.K.), and by grants from the National Institutes of Health [BRSG RR-05370, U.S. Public Health Service (P.J.K.), and AM 25731 (W.J.D.)].

This work was presented in part at the 88th Annual Meeting of the American Gastroenterological Association in Chicago, Illinois, on May 11, 1987, and was published in abstract form in Gastroenterology 1987;92:1458.

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