Upper esophageal sphincter opening and modulation during swallowing
Open accessAbstract
Studies were done on 8 normal subjects with synchronized videofluoroscopy and manometry to facilitate a biomechanical analysis of upper esophageal sphincter opening and volume-dependent modulation during swallowing. Movements of the hyoid and larynx, dimensions of sphincter opening, and intraluminal sphincter pressure were determined at 1/30th-s intervals during swallows of 1, 5, 10, and 20 ml of liquid barium. Our analysis subdivided upper esophageal sphincter activity during swallowing into five phases: (a) relaxation, (b) opening, (c) distention, (d) collapse, and (e) closure. Sphincter relaxation occurred during laryngeal elevation and preceded opening by a mean period of 0.1 s. Opening occurred as the sphincter was pulled apart via muscular attachments to the hyoid such that the hyoid coordinates at which sphincter opening and closing occurred were constant among bolus volumes. Sphincter distention after opening was modulated by intrabolus pressures rather than graded hyoid movement. The generation of intrabolus pressure coincided with the posterior thrust of the tongue that culminated in pharyngeal wall contact and the initiation of pharyngeal peristalsis. Larger volume swallows were associated with greater intrabolus pressure and increased bolus head velocity. The duration of sphincter opening increased in conjunction with a prolongation of the anterior-superior excursion of the hyoid and a delay in the onset of pharyngeal peristalsis (the event that determined the timing of sphincter closure). We conclude that transsphincteric transport of increasing swallow bolus volumes is accomplished by modulating sphincter diameter, opening interval, and flow rate (reflected by bolus head velocity). Furthermore, upper esophageal sphincter opening is an active mechanical event rather than simply a consequence of cricopharyngeal relaxation.
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The importance of hyoid excursion in UES opening is well-documented, and impaired hyoid excursion can lead to aspiration.
“The importance of hyoid excursion in UES opening is well-documented27,28 and impaired hyoid excursion can lead to aspiration.29,30”
From Classification of high-resolution manometry data according to videofluoroscopic parameters using pattern recognition (2013) · cites this paper as [28]
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- Authors
- Jacob, P., Kahrilas, P. J., Logemann, J. A., Shah, V., & Ha, T.
- Affiliations
- Northwestern University (US)
- ORCID
- Kahrilas, P.J.
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 1989-12
- Volume
- 97
- Issue
- 6
- Pages
- 1469-1478
- ISSN
- 0016-5085 (ISSN-L)
- OpenAlex
- W1673776160
- Cited by
- 426
- References
- 15
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 4 · 2023: 11 · 2022: 18 · 2021: 16 · 2020: 15 · 2019: 17 · 2018: 17 · 2017: 13 · 2016: 11 · 2015: 23 · 2014: 17 · 2013: 10 · 2012: 15
- FWCI
- 43.50
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- U.S. Public Health Service (0821201)
- National Cancer Institute (P01CA040007)
- Topics
- Health Sciences › Health Professions › Speech and Hearing › Dysphagia Assessment and Management
- Health Sciences › Medicine › Gastroenterology › Gastroesophageal reflux and treatments
- Health Sciences › Medicine › Physiology › Voice and Speech Disorders
- Keywords
- upper esophageal sphincter, swallowing, bolus volume, hyoid movement, laryngeal elevation, intrabolus pressure, pharyngeal peristalsis, esophageal manometry, videofluoroscopy
- MeSH terms
- Adult, Deglutition, Esophagogastric Junction, Fluoroscopy, Humans, Hyoid Bone, Larynx, Male, Manometry, Pharynx, Reference Values, Tongue
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