Upper and lower esophageal sphincter kinetics are modified during maturation: effect of pharyngeal stimulus in premature infants.

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Upper and lower esophageal sphincter kinetics are modified during maturation: effect of pharyngeal stimulus in premature infants.

Pediatr Res. 2015 Jan;77(1-1):99-106

Authors: Jadcherla SR, Shubert TR, Gulati IK, Jensen PS, Wei L, Shaker R

Abstract
BACKGROUND: We hypothesized that changes in proximal and distal esophageal sphincter kinetics evoked upon pharyngeal provocation undergo longitudinal maturation.
METHODS: Pharyngeal stimulation-induced reflexes were characterized using novel pharyngo-esophageal motility methods in 19 healthy premature neonates, studied at 34.7 ± 0.8 wk (time-1) and 39.3 ± 1.1 wk postmenstrual age (time-2). Graded volumes of air (290 infusions) and sterile water (172 infusions) were infused to define sensory-motor characteristics of upstream (pharyngeal reflexive swallow, PRS) and downstream (pharyngo-lower esophageal sphincter relaxation reflex, PLESRR) esophageal reflexes. Data displayed as mean ± SE.
RESULTS: Threshold volumes were similar with air and water for PRS and PLESRR at time-1 and time-2. Multiple PRS responses were noted with water stimulus and were different between the media (time-1 vs. air, P < 0.0001; time-2 vs. air, P = 0.0003). Dose-response relationships for water were significant (P < 0.01 for PRS and PLESRR time-1 and time-2), but not with air.
CONCLUSION: Significantly, the recruitment frequency of PRS and PLESRR increases with maturation, liquid is a superior medium for evoking such swallowing reflexes, and stimulus-response relationships for these reflexes are evident. These changes in aerodigestive protective reflexive activity may indicate differences in modulation of excitatory and inhibitory pathways during longitudinal postnatal maturation.

PMID: 25279989 [PubMed - indexed for MEDLINE]

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