Child ; Humans ; Manometry ; Esophagus/physiology*

The zero-stress state of the esophagus is the state in which the esophagus is stress-free. It is in close correlation with physiology and pathology of the esophagus. The purpose of the review is to describe briefly the basic theory of zero-stress state and its physiological and pathologic implications in the esophagus.
Esophagus ; physiology ; physiopathology ; Humans ; Stress, Physiological

Transient lower esophageal sphincter (LES) relaxation (TLESR) is defined as LES relaxation without a swallow. TLESRs are observed in both of the normal individuals and the patients with gastroesophageal reflux disorder (GERD). However, TLESR is widely considered as the major mechanism of the GERD. The new equipments such as high resolution manometry and impedance pH study is helped to understand of TLESR and the related esophageal motor activities. The strong longitudinal muscle contraction was observed during development of TLESR. Most of TLESRs are terminated by TLESR related motor events such as primary peristalsis and secondary contractions. The majority of TLESRs are associated with gastroesophageal reflux. Upper esophageal sphincter (UES) contraction is mainly associated with liquid reflux during recumbent position and UES relaxation predominantly related with air reflux during upright position. The frequency of TLESR in GERD patients seems to be not different compared to normal individuals, but the refluxate of GERD patients tend to be more acidic during TLESR.
Esophageal Sphincter, Lower/*physiology ; Esophagogastric Junction/physiology ; Esophagus/*physiology ; Gastroesophageal Reflux/*physiopathology ; Humans ; Muscle Relaxation/physiology

Dysphagia incidence can be up to 90% of patients after CVA disease and most of the patients demonstrate speech problems as well as dysphagia. The term of swallowing includes the entire process of deglutition from the placement of food in the mouth until the food enters to the esophagus through the oral and pharyngeal cavities. Swallowing functions share common anatomic structures and characteristics of physiology with speech in many aspects. Therefore, speech-language pathologists can help people with swallowing disorders. Herein the approaches and rationales for improving speech and swallowing functions in patients with stroke need to be discussed depending on the lesion sites of the brain.
Brain ; Deglutition Disorders ; Deglutition* ; Esophagus ; Humans ; Incidence ; Mouth ; Physiology ; Stroke*

OBJECTIVETo examine the esophageal function of neonates by high resolution manometry (HRM), and to provide preliminary data for research on the esophageal function of neonates.

METHODSEsophageal HRM was performed on neonates using a solid-state pressure measurement system with 36 circumference sensors arranged at intervals of 0.75 cm, and ManoView software was used to analyze esophageal peristalsis pattern.

RESULTSEsophageal HRM was performed successfully in 11 neonates, and 126 occurrences of complete esophageal peristalsis were recorded. Complete esophageal peristalsis with pressure increase was recorded in some neonates but most neonates showed a different esophageal peristalsis pattern compared with adults. Some neonates had no relaxation of the upper esophageal sphincter (UES) when pharyngeal muscles contracted in swallowing, some neonates had multiple swallowing without esophageal peristalsis and some neonates had relatively low pressure of esophageal peristalsis. Full-term infants could have relatively low UES pressure and esophageal sphincter (LES) pressure but some preterm infants showed relatively high UES pressure and LES pressure. Longitudinal contraction of the whole esophagus and elevation of LES after swallowing were recorded in some neonates.

CONCLUSIONSEsophageal HRM is safe and tolerable for neonates. HRM shows that esophageal peristalsis after swallowing may not occur or may be incomplete in neonates. The esophageal function of neonates has not yet been developed completely, with large individual differences in esophageal peristalsis. Large sample data are needed for further analysis and research on the esophageal function of neonates.

Deglutition ; physiology ; Esophageal Sphincter, Lower ; physiology ; Esophageal Sphincter, Upper ; physiology ; Esophagus ; physiology ; Female ; Humans ; Infant, Newborn ; Male ; Manometry ; methods ; Peristalsis

Swallowing is a rare cause of neurally mediated syncope. The mechanism of swallow syncope that contributes to hypotension, bradycardia, or to both is complex. A 59-year-old man had experienced a recurrent loss of consciousness during swallowing of carbonated beverages or sticky foods. Another 59-year-old man had complained of intermittent syncope just after eating foods. These two patients had no significant structural or functional abnormalities in the esophagus or heart. Both cases showed bradycardia when the lower esophagus was stretched by balloon inflation. The activation of mechanoreceptors in the lower esophagus can be regarded as an initiating factor of these cardioinhibitions. The patients were treated with permanent pacemaker implantation and instructed to change eating habits, respectively.
Bradycardia/etiology ; Deglutition/*physiology ; Esophagus/*innervation ; Humans ; Male ; Mechanoreceptors/*physiology ; Middle Aged ; Syncope/*etiology

Intraganglionic laminar endings (IGLEs) have been supposed to be the mechanoreceptors in the gut by electrophysiological recording techniques. But the specialized morphology of IGLEs could not be displayed closely associated with this function and the mechanism that IGLEs act as the mechanotransduction sites in the gut is not yet well understood. In the present study, we used styryl dye FM1-43 combined with stretch stimulation in the guinea pig esophagus to test whether IGLEs acted as the mechano-sensitive receptors of the vagal afferent nerves. At the same time, the special structure of IGLEs displayed by FM1-43 was further confirmed by neurobiotin anterograde labeling technique. To further investigate the characteristics of IGLEs as mechanosensitive receptors, different drugs were used to block or stimulate IGLEs activation. Our results indicated that only in the stretched preparation could FM1-43 enter the IGLEs and completely display their specialized structure, which was consistent with that shown by neurobiotin. The amount of IGLEs shown by stretch-evoked FM1-43 staining was much more than that shown without stretch stimulation [(90.4 +/- 9.5) % vs (10.7 +/- 2.1) %, P<0.05]. Ca(2+), TTX (0.6 mumol/L), atropine (0.6 mumol/L), SKF (50 mumol/L), and gadolium (100 mumol/L) had no effect on the IGLEs activation. But for benzamil (100 mumol/L), an epithelial sodium channel blocker, activation of IGLEs by stretch stimulation was significantly blocked. The potent ATP analogue, alpha,beta-methylene ATP (100 mumol/L) could not activate FM1-43 staining without stretch. These results indicate that IGLEs are sensitive to mechanical stimulation. This could lead to the deduction that IGLEs act as the mechanoreceptors of vagal afferent nerve. IGLEs could transmit mechanical stimuli directly through ion channels, independent of neurotransmitter release and action potential propagation. The stretch-sensitive channels on IGLEs probably belong to the epithelial sodium channel family rather than voltage-gated sodium ion channels. Furthermore, styryl dye FM1-43 is a useful activity-dependent marker to demonstrate the structure and function of IGLEs in guinea pig esophagus.
Afferent Pathways ; physiology ; Animals ; Esophagus ; innervation ; Female ; Ganglia, Autonomic ; physiology ; Guinea Pigs ; Male ; Mechanoreceptors ; physiology ; Nerve Endings ; physiology ; Vagus Nerve ; physiology

BACKGROUND/AIMS: Disturbances of esophageal motility have been reported to be more frequent the aged population. However, the physiology of disturbances in esophageal motility during aging is unclear. The aim of this study was to evaluate the effects of age on esophageal motility using high-resolution esophageal impedance manometry (HRIM). METHODS: Esophageal motor function of 268 subjects were measured using HRIM in 3 age groups, < 40 years (Group A, n = 32), 40–65 years (Group B, n = 185), and > 65 years (Group C, n = 62). Lower esophageal sphincter (LES) and upper esophageal sphincter (UES) pressures, integrated relaxation pressure, distal contractile integral, contractile front velocity, distal latency, and pressures and duration of contraction on 4 positions along the esophagus, and complete bolus transit were measured. RESULTS: Basal UES pressure was lower in Group C (P < 0.001) but there was no significant difference in the LES pressure among groups. Contractile duration on position 3 (10 cm from proximal LES high pressure zone) was longer in Group C (P = 0.001), and the contractile amplitude on position 4 (5 cm from proximal LES high pressure zone) was lower in Group C (P = 0.005). Distal contractile integral was lower in Group C (P = 0.037). Contractile front velocity (P = 0.015) and the onset velocity (P = 0.040) was lower in Group C. There was no significant difference in impedance values. CONCLUSIONS: The decrease of UES pressure, distal esophageal motility, and peristaltic velocity might be related with esophageal symptoms in the aged population.
Aging ; Electric Impedance* ; Esophageal Sphincter, Lower ; Esophageal Sphincter, Upper ; Esophagus ; Humans ; Manometry* ; Physiology ; Relaxation

BACKGROUND AND OBJECTIVES: The two most important methods for voice rehabilitation after total laryngectomy are tracheoesophageal speech and esophageal speech. The former can be obtained in several ways, for example, by the primary Amatsu tracheoesophageal (T-E) shunt operation or by the use of a low-resistance valve such as the Provox prosthesis. The purpose of this investigation was to study the anatomy and physiology of the neoglottis and to evaluate the vocal quality of tracheoesophageal speech. MATERIALS AND METHODS: A total of 12 patients, who had undergone the Amatsu T-E shunt operation after total laryngectomy, were analyzed using the stroboscopy, laryngofiberscopy, videofluoroscopy, and computerized speech lab. RESULTS: With stroboscopy, the neoglottis was split from left to right in 3 patients and in 9 patients, the direction of opening and closure of rheeoglottis was anterior-posterior. The regular vibratory features were observed in patients with a shortened visible vibratorvsegment. The results of videofluoroscopy indicate that the location of the vibration was mostly situated between C3 and C5. The cervical esophagus closure during tracheoesophageal phonation was located at a level between C7-T2. CONCLUSION: The anatomical and morphological characteristics of the neoglottis was related to the healing process after operation. The neoglottis was considered to be formed by the thyropharyngeal muscle, and concentric contraction under subneoglottic extension was formed by the contraction of the cervical esophagus.
Acoustics* ; Esophagus ; Humans ; Laryngectomy ; Phonation ; Physiology ; Prostheses and Implants ; Rehabilitation ; Speech, Esophageal ; Stroboscopy ; Vibration ; Voice

The basement membrane (BM) is crucial in regulating the physical and biological activities of esophageal epithelial cells which attach to the underlying BM. In order to simulate the natural construction of BM, we prepared the fibrous scaffolds using biodegradable polylactide (PLA) and silk fibroin (SF) as the materials via electrospinning technology. BM's proteins containing collagen (IV), laminin, entactin and proteoglycan were extracted from porcine esophagus and coated on the eletrospun fibers. Morphology, mechanical strength, biodegradability and cytocompatibility of the coated and uncoated scaffolds were tested and evaluated using scanning electron micrography, mechanical test system, immunofluorescence assay and western blotting with CK14 as the primary antibody. The fibrous scaffold PLA or PLA/SF, generated from the present protocol had good formation and mechanical and biodegradable properties. After coating with BM's proteins, the scaffold could enhance the growth and differentiation of esophageal epithelial cells, which would contribute to remodel and regenerate the tissue engineered epithelium and further contribute to engineer the whole esophagus in future.
Absorbable Implants ; Basement Membrane ; Biocompatible Materials ; chemistry ; Epithelium ; Esophagus ; physiology ; Fibroins ; chemistry ; Humans ; Nanostructures ; chemistry ; Polyesters ; chemistry ; Regeneration ; physiology ; Tissue Engineering ; methods ; Tissue Scaffolds ; chemistry