Characterization and mechanisms of the pharyngeal swallow activated by stimulation of the esophagus
Characterization and mechanisms of the pharyngeal swallow activated by stimulation of the esophagus
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DOI：
10.1152/ajpgi.00291.2016
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发表时间：
2016-11-01
影响因子：
4.5
通讯作者：
Shaker, Reza
中科院分区：
文献类型：
--
作者：
Lang, Ivan M.;Medda, Bidyut K.;Shaker, Reza
刺激食道激活人类婴儿和动物的咽部吞咽反应（EPSR）。本研究的目的是描述EPSR的刺激和反应，并确定产生EPSR的功能和机制。在46只去脑猫中进行了研究，其中咽，喉和食管运动监测使用肌电图，应变计，或测压。通过球囊扩张或腔内液体输注刺激食管。我们发现食管扩张增加了EPSR发生的机会，但延迟是可变的。发生EPSR的机会与食管内刺激的位置、大小和长度有关。最有效的刺激是长，强，并位于颈段食管。食管酸化激活咽吞咽并致敏激活EPSR的受体。通过在食管腔施加局部麻醉来阻断EPSR，并且电刺激环状软骨（RLNc）尾部的喉返神经激活咽吞咽反应。我们的结论是，EPSR被激活的概率的方式。介导EPSR的受体可能是粘膜慢适应性张力受体。感觉神经通路包括RLNc和上级喉神经。我们假设，因为EPSR是在人类婴儿和动物中观察到的，而不是人类成年人，EPSR的激活与喉的位置升高有关。在这种情况下，发生EPSR，而不是继发性食管反流，以防止食管上反流时，食管食团是在近端食管。
Stimulation of the esophagus activates the pharyngeal swallow response (EPSR) in human infants and animals. The aims of this study were to characterize the stimulus and response of the EPSR and to determine the function and mechanisms generating the EPSR. Studies were conducted in 46 decerebrate cats in which pharyngeal, laryngeal, and esophageal motility was monitored using EMG, strain gauges, or manometry. The esophagus was stimulated by balloon distension or luminal fluid infusion. We found that esophageal distension increased the chance of occurrence of the EPSR, but the delay was variable. The chance of occurrence of the EPSR was related to the position, magnitude, and length of the stimulus in the esophagus. The most effective stimulus was long, strong, and situated in the cervical esophagus. Acidification of the esophagus activated pharyngeal swallows and sensitized the receptors that activate the EPSR. The EPSR was blocked by local anesthesia applied to the esophageal lumen, and electrical stimulation of the recurrent laryngeal nerve caudal to the cricoid cartilage (RLNc) activated the pharyngeal swallow response. We conclude that the EPSR is activated in a probabilistic manner. The receptors mediating the EPSR are probably mucosal slowly adapting tension receptors. The sensory neural pathway includes the RLNc and superior laryngeal nerve. We hypothesize that, because the EPSR is observed in human infants and animals, but not human adults, activation of EPSR is related to the elevated position of the larynx. In this situation, the EPSR occurs rather than secondary peristalsis to prevent supraesopha-geal reflux when the esophageal bolus is in the proximal esophagus.