Faculty Collaboration Database

Protective role of aerodigestive reflexes against aspiration: study on subjects with impaired and preserved reflexes. Gastroenterology 2011 Jun;140(7):1927-33

Date

03/23/2011

Pubmed ID

21420407

Pubmed Central ID

PMC3425443

DOI

10.1053/j.gastro.2011.03.012

Scopus ID

2-s2.0-79958083726 (requires institutional sign-in at Scopus site)   31 Citations

Abstract

BACKGROUND & AIMS: Direct evidence to support the airway protective function of aerodigestive reflexes triggered by pharyngeal stimulation was previously demonstrated by abolishing these reflexes by topical pharyngeal anesthesia in normal subjects. Studies have also shown that these reflexes deteriorate in cigarette smokers. Aim of this study was to determine the influence of defective pharyngeal aerodigestive reflexes on airway protection in cigarette smokers.

METHODS: Pharyngoglottal Closure reflex; PGCR, Pharyngo-UES Contractile reflex; PUCR, and Reflexive Pharyngeal Swallow; RPS were studied in 15 healthy non-smokers (24.2±3.3 SD y, 7 males) and 15 healthy chronic smokers (27.3±8.1, 7 males). To elicit these reflexes and to evaluate aspiration, colored water was perfused into the hypopharynx at the rate of 1 mL/min. Maximum volume of water that can safely dwell in the hypopharynx before spilling into the larynx (Hypopharyngeal Safe Volume; HPSV) and the threshold volume to elicit PGCR, PUCR, and RPS were determined in smokers and results compared with non-smokers.

RESULTS: At baseline, RPS was elicited in all non-smokers (100%) and in only 3 of 15 smokers (20%; P<.001). None of the non-smokers showed evidence of laryngeal spillage of water, whereas 12 of 15 smokers with absent RPS had laryngeal spillage. Pharyngeal anesthesia abolished RPS reflex in all non-smokers resulting in laryngeal spillage. The HPSV was 0.61±0.06 mL and 0.76±0.06 mL in non-smokers and smokers respectively (P=.1).

CONCLUSIONS: Deteriorated reflexive pharyngeal swallow in chronic cigarette smokers predispose them to risks of aspiration and similarly, abolishing this reflex in non-smokers also results in laryngeal spillage. These observations directly demonstrate the airway protective function of RPS.

Author List

Dua K, Surapaneni SN, Kuribayashi S, Hafeezullah M, Shaker R

Authors

Kulwinder S. Dua MD Professor in the Medicine department at Medical College of Wisconsin
Reza Shaker MD Assoc Provost, Sr Assoc Dean, Ctr Dir, Chief, Prof in the Medicine department at Medical College of Wisconsin

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

Adult
Case-Control Studies
Deglutition
Electromyography
Female
Gagging
Glottis
Humans
Laryngopharyngeal Reflux
Laryngoscopy
Male
Manometry
Pharynx
Pressure
Reflex, Abnormal
Sensory Thresholds
Smoking
Video Recording
Wisconsin
Young Adult