Influence of Acid Swallows on the Dynamics of the Upper Esophageal Sphincter
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ORIGINAL ARTICLE
Influence of Acid Swallows on the Dynamics of the Upper Esophageal Sphincter Simone Miller1 · Martin Ptok1 · Michael Jungheim1 Received: 10 March 2020 / Accepted: 10 July 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Mechanisms of the upper esophageal sphincter (UES) when exposed to acid are still incompletely understood. The presented work investigated the reaction of the UES to acid exposure during swallowing. Ten healthy individuals swallowed ten 2 ml neutral water boli of pH 7, followed by 10 swallows each of different levels of acidity (pH 1.8, pH 3 and pH 5). Effects were analyzed by high-resolution manometry (HRM) for the primary parameter Restitution Time, as well as Resting Pressures, maximal, minimal pressures and time intervals. Restitution Times measured mean values of 12.67 s (SD ± 7.03 s) for pH 1.8, pH 7 = 8.69 s (SD ± 2.72 s), pH 3 = 7.56 s (SD ± 2.23 s) and pH 5 = 7.29 s (SD ± 2.55 s), showing prolonged Restitution Times in the UES when exposed to strong bolus acidity. This difference was significant towards the neutral bolus, but also to less acidic boli (pH 5: p = 0.006, pH 3: p = 0.009, pH 7: p = 0.038). Considerable differences of mean values were found for Post-Swallow Maximum and Period of Sphincter Activity. Also, Pre-Swallow Maximum values were found to be highest with the strongest acid. Relaxation Times showed a slight trend of prolongation for the highest bolus acidity. Prolonged Restitution Times may represent a reflexive protective mechanism triggered by receptors in the pharyngeal mucosa or the UES preventing regurgitation of acid into the pharynx and larynx, besides representing ongoing attempts of acid clearance. Exposure to high levels of acidity by a swallowed bolus does influence UES functions during swallowing. Keywords Acid · Upper esophageal sphincter · Restitution time · High-resolution manometry · Swallow · Deglutition
Background and Aims The upper esophageal sphincter (UES) denotes the pharyngo-esophageal segment. It presents with permanent pressure during its state of rest in order to prevent regurgitation of material into the pharynx and air ingestion into the esophagus [1]. Apart from this, it has an important function during swallowing—as it needs to relax and open in order to let the bolus pass—and is postulated to act as a barrier to Data were partly presented at the 36th annual meeting of the German Society of Phoniatrics and Pediatric Audiology (DGPP); September 19-22, 2019; Göttingen, Germany. As well as being part of the dissertation thesis: Miller S. (2017) Bolus acidity and swallow associated behaviour of the upper esophageal sphincter. Dissertation. Medizinische Hochschule Hannover. * Simone Miller miller.simone@mh‑hannover.de 1
Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Carl‑Neuberg‑Straße 1, Hannover, Germany
prevent pharyngolaryngeal reflux [2]. Sphincter pressures are influenced by a number of factors and may vary in relation with the state of arousal, state
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