Functional Changes of the Upper Esophageal Sphincter in Gastroesophageal Reflux

Abstract

Introduction The upper esophageal sphincter (UES) is a muscular structure located at the transition from the pharynx to the esophagus, with the cricopharyngeal muscle as the most important component. During gastroesophageal reflux, the pressure in the UES elevates, which is apparently a protective mechanism to prevent esophagopharyngeal reflux and airway aspiration. In gastroesophageal reflux disease (GERD), there may be functional changes in the UES. Objective The objective of the present review was to determine UES functional changes in GERD. Data Synthesis In healthy individuals, gastroesophageal reflux causes an increase in the UES pressure. This response of the sphincter is at least partially impaired in patients with GERD. In the disease, the UES has a reduced length and decreased resting pressure. However, other publications found that in chronic gastroesophageal reflux the basal sphincter pressure increase, differences which may be consequent to the measurement method or to disease severity. The UES opening during swallowing has a smaller diameter, and the bolus transit time through the sphincter is longer. Conclusion The UES of patients with GERD does not open as expected and the bolus flow through the sphincter is longer. This behavior may be associated with dysphagia, a frequent complaint in patients with GERD.

Correlation Between Symptoms and Reflux in Patients With Gastroesophageal Reflux Disease

“…Cultural diversity has a significant influence on the expression of troublesome symptoms (7,8) . Dysphagia in GERD may be caused by upper esophageal sphincter dysfunction (36) , esophageal hypersensitivity, and/or esophageal dysmotility (22) . Dysphagia is correlated with the overall gastroesophageal reflux symptoms -particularly heartburn, whose treatment decreases dysphagia frequency (33,37) , reinforcing the association between them.…”

A One Health review of aerodigestive disease in dogs

“…In people, there is an association between acquired cricopharyngeal dyssynchrony and reflux disease (GERD and EERD). These studies documented abnormalities in the timing of cricopharyngeal opening, with as many as 50% of dogs with GERD showing delayed opening or early closure of the cricopharyngeus muscle 223,224 . As for pharyngeal weakness, detection of cricopharyngeal achalasia and dyssynchrony is best achieved by HRM or VFSS with special attention paid to the PCR, timing of pharyngeal swallow, and the maximal diameter of the UES during bolus passage 129,216,225 …”

Normal Variations in Upper Esophageal Sphincter Function During Deglutition: A Secondary Analysis of Videofluoroscopic Data

“…The upper esophageal sphincter (UES), which is predominately composed of the cricopharyngeus (CP) and inferior pharyngeal constrictor muscles, acts as a gateway between the pharynx and cervical esophagus 1,2 . At rest, the UES remains tonically contracted to prevent the entrance of air into the esophagus and retrograde flow of esophagogastric contents into the pharynx 2–4 . Timely and sufficient relaxation of the CP muscle, in conjunction with anterosuperior hyolaryngeal traction and adequate intrabolus force, allows the UES to open 5–7 .…”

“…1,2 At rest, the UES remains tonically contracted to prevent the entrance of air into the esophagus and retrograde flow of esophagogastric contents into the pharynx. [2][3][4] Timely and sufficient relaxation of the CP muscle, in conjunction with anterosuperior hyolaryngeal traction and adequate intrabolus force, allows the UES to open. [5][6][7] This concerted effort of movements facilitates airway protection and bolus efficiency as the material is propagated to the esophagus.…”