Document Detail


Physiology of esophageal sensorimotor malfunctions in neonatal neurological illness.
MedLine Citation:
PMID:  23328206     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We aimed to define the sensorimotor characteristics of aero-digestive reflexes evoked upon midesophageal provocations in neuropathology infants. Provocative esophageal motility testing was performed in 20 neuropathology infants and 10 controls at 42.3 ± 0.6 and 38.9 ± 0.9 wk postmenstrual age. Data from 1,073 infusions were examined for the sensory thresholds, response frequencies, response magnitude of upper esophageal sphincter (UES) contractile reflexes, lower esophageal sphincter (LES) relaxation reflexes, and peristaltic reflexes using mixed statistical models. Threshold volumes for air and liquid in neuropathology and control infants were similar for all reflexes. Graded air- and liquid volume-dependent UES contractile reflex, LES relaxation reflex, and peristaltic reflex frequency recruitment were present in neuropathology and control subjects for the media (P < 0.0001) and the reflexes (P < 0.0001). In neuropathology infants (vs. controls), UES contractile magnitude is higher (P < 0.0001); LES relaxation reflex occurred earlier (P = 0.008); LES nadir duration lasted longer (P = 0.006); secondary peristalsis is the chief method of esophageal clearance (P < 0.0001); pharyngeal swallows and deglutition apneas are less frequent (P = 0.001); proximal, midesophageal waveform magnitudes and duration are exaggerated (P < 0.008). UES contractile reflex was longer with liquid than air in both groups (P = 0.03). We concluded that 1) perception to midesophageal provocation remains preserved in neuropathology neonates; 2) sustained and exaggerated myogenic response from afferent activation is evident by increased excitatory efferent outputs to the UES and esophageal body and increased inhibitory efferent outputs to the LES; 3) dysfunctional regulation of pharyngeal swallowing and infrequent deglutition responses indicate the possibility of impaired descending modulation and central malfunctions of brainstem and vagal nuclei.
Authors:
Sudarshan R Jadcherla; Chin Yee Chan; Rebecca Moore; Soledad Fernandez; Reza Shaker
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2013-01-17
Journal Detail:
Title:  American journal of physiology. Gastrointestinal and liver physiology     Volume:  304     ISSN:  1522-1547     ISO Abbreviation:  Am. J. Physiol. Gastrointest. Liver Physiol.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-03-18     Completed Date:  2013-05-24     Revised Date:  2014-03-26    
Medline Journal Info:
Nlm Unique ID:  100901227     Medline TA:  Am J Physiol Gastrointest Liver Physiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  G574-82     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Electromyography / methods*
Esophageal Motility Disorders* / diagnosis,  etiology,  physiopathology
Esophageal Sphincter, Lower / physiopathology*
Esophageal Sphincter, Upper / physiopathology*
Evoked Potentials, Somatosensory
Female
Gestational Age
Humans
Infant, Newborn
Male
Manometry / methods*
Methods
Nervous System Diseases / classification,  complications*,  physiopathology
Peristalsis
Reflex, Abnormal
Grant Support
ID/Acronym/Agency:
R01 DK 068158/DK/NIDDK NIH HHS; UL1 TR000055/TR/NCATS NIH HHS; UL1 TR000090/TR/NCATS NIH HHS
Comments/Corrections

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