PediatricResearch(2015)77,99–106
doi:10.1038/pr.2014.147
Upperandloweresophagealsphincterkineticsaremodifiedduringmaturation:effectofpharyngealstimulusinprematureinfants
SudarshanR.Jadcherla,TheresaR.Shubert,IshK.Gulati,PreceousaS.Jensen,
LaiWeiRezaShaker
Abstract
Background:
Wehypothesizedthatchangesinproximalanddistalesophagealsphincterkineticsevokeduponpharyngealprovocationundergolongitudinalmaturation.
Methods:
Pharyngealstimulation-inducedreflexeswerecharacterizedusingnovelpharyngo-esophagealmotilitymethodsin19healthyprematureneonates,studiedat34.7 &plun; 0.8 wk(time-1)and39.3 &plun; 1.1 wkpostmenstrualage(time-2).Gradedvolumesofair(290infusions)andsterilewater(172infusions)wereinfusedtodefinesensory-motorcharacteristicsofupstream(pharyngealreflexiveswallow,PRS)anddownstream(pharyngo-loweresophagealsphincterrelaxationreflex,PLESRR)esophagealreflexes.Datadisplayedaean&plun;SE.
Results:
ThresholdvolumesweresimilarwithairandwaterforPRSandPLESRRattime-1andtime-2.MultiplePRSresponseswerenotedwithwaterstimulusandweredifferentbetweenthemedia(time-1vs.air,P<0.0001;time-2vs.air,P=0.0003).Dose–responserelationshipsforwaterweresignificant(P<0.01forPRSandPLESRRtime-1andtime-2),butnotwithair.
Conclusion:
Significantly,therecruitmentfrequencyofPRSandPLESRRincreaseswithmaturation,liquidisasuperiormediumforevokingsuchswallowingreflexes,andstimulus-responserelationshipsforthesereflexesareevident.Thesechangesinaerodigestiveprotectivereflexiveactivitymayindicatedifferencesinmodulationofexcitatoryandinhibitorypathwaysduringlongitudinalpostnatalmaturation.
