Medical College of Wisconsin
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Upper and lower esophageal sphincter kinetics are modified during maturation: effect of pharyngeal stimulus in premature infants. Pediatr Res 2015 Jan;77(1-1):99-106

Date

10/04/2014

Pubmed ID

25279989

Pubmed Central ID

PMC4268006

DOI

10.1038/pr.2014.147

Scopus ID

2-s2.0-84927916843 (requires institutional sign-in at Scopus site)   36 Citations

Abstract

BACKGROUND: We hypothesized that changes in proximal and distal esophageal sphincter kinetics evoked upon pharyngeal provocation undergo longitudinal maturation.

METHODS: Pharyngeal stimulation-induced reflexes were characterized using novel pharyngo-esophageal motility methods in 19 healthy premature neonates, studied at 34.7 ± 0.8 wk (time-1) and 39.3 ± 1.1 wk postmenstrual age (time-2). Graded volumes of air (290 infusions) and sterile water (172 infusions) were infused to define sensory-motor characteristics of upstream (pharyngeal reflexive swallow, PRS) and downstream (pharyngo-lower esophageal sphincter relaxation reflex, PLESRR) esophageal reflexes. Data displayed as mean ± SE.

RESULTS: Threshold volumes were similar with air and water for PRS and PLESRR at time-1 and time-2. Multiple PRS responses were noted with water stimulus and were different between the media (time-1 vs. air, P < 0.0001; time-2 vs. air, P = 0.0003). Dose-response relationships for water were significant (P < 0.01 for PRS and PLESRR time-1 and time-2), but not with air.

CONCLUSION: Significantly, the recruitment frequency of PRS and PLESRR increases with maturation, liquid is a superior medium for evoking such swallowing reflexes, and stimulus-response relationships for these reflexes are evident. These changes in aerodigestive protective reflexive activity may indicate differences in modulation of excitatory and inhibitory pathways during longitudinal postnatal maturation.

Author List

Jadcherla SR, Shubert TR, Gulati IK, Jensen PS, Wei L, Shaker R

Author

Reza Shaker MD Professor in the Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Deglutition
Esophageal Sphincter, Lower
Esophageal Sphincter, Upper
Esophagus
Humans
Infant, Newborn
Infant, Premature
Longitudinal Studies
Manometry
Peristalsis
Pharynx
Reflex
Sensory Thresholds