Correlation of deglutitive striated esophagus motor function and pharyngeal phase swallowing biomechanical events.

ABSTRACT

BACKGROUND: The functional relationship of striated esophagus (St.Eso) motor function with pharyngeal deglutitive biomechanical events has not been systematically studied. The aim of this study was to determine the spatio-temporal characteristics of St.Eso function and its correlation with pharyngeal biomechanics and bolus transport. METHODS: We studied 50 healthy volunteer subjects (age range 21-82 years, 31 female) by digital videofluoroscopy. All subjects were studied in a seated, upright position. Thirteen of these 50 volunteers also underwent high-resolution manometry (HRM) concurrent with fluoroscopy. We used laryngeal excursion as a surrogate for St.Eso excursion. KEY RESULTS: Median duration of St.Eso excursion was 2.35 [1.93,2.85, 5th and 95th percentile] seconds. Mean maximum extent of St.Eso excursion was 2.84 ± 0.72 cm. We identified four distinct periods in deglutitive St.Eso motor function P1. Anterosuperior ascent without bolus or peristaltic activity, P2. Non-peristaltic bolus receiving at the apogee of St.Eso excursion concurrent with UES opening and pharyngeal peristalsis P3. Peristaltic bolus transport as St.Eso descends and P4. Continued peristalsis in resting position. CONCLUSIONS AND INFERENCES 1. St.Eso motor function spans both pharyngeal and esophageal phases of swallowing for receiving and transporting the bolus, 2. Pressure signatures in HRM recordings currently attributed to St.Eso deglutitive motor activity does not represent the entirety of St.Eso peristalsis, only the part that occurs in its resting position. St.Eso peristalsis that occurs during its descent is recorded by pressure sensors initially in the pharynx. This finding needs to be considered when interpreting HRM recordings of the pharynx and proximal esophagus.