Loss of Secondary Esophageal Peristalsis is Not a Contributory Pathogenetic Factor in Posterior Laryngitis

Abstract

Secondary esophageal peristalsis helps prevent the entry of gastric acid into the pharynx by clearing the refluxed gastric contents back into the stomach. Because the loss of this mechanism may contribute to the pathogenesis of reflux-induced laryngeal disorders, our aim was to study the frequency of stimulation and parameters of secondary esophageal peristalsis in patients with posterior laryngitis (PL). We studied 14 patients (45 +/- 5 years) with PL documented by videolaryngoscopy and 11 healthy controls (46 +/- 6 years). The upper esophageal sphincter (UES) pressure was monitored by a sleeve assembly incorporating an injection port 5 cm distal to the sleeve. The esophageal body and lower esophageal sphincter (LES) pressures were measured by an LES sleeve assembly. Primary esophageal peristalsis was induced by 5-mL water swallows. Secondary esophageal peristalsis was induced by abrupt injection of volumes of air, incrementally increased by 5 mL, into the esophagus. Secondary esophageal peristalsis could not be elicited by injection of any volume (up to 60 mL) in 3 PL patients and 2 controls. These 5 subjects had normal primary peristalsis. The threshold volume of air required to stimulate secondary esophageal peristalsis in PL patients (median, 15 mL) was similar to that of controls (median, 10 mL). The parameters of the secondary esophageal peristaltic pressure wave were similar in both groups, and in both groups, they were similar to those of primary peristalsis. The UES response to the injection of the threshold volume that induced secondary esophageal peristalsis in PL patients was contraction in 58% of the trials, partial relaxation in 3%, and no response in 39%. The findings were similar to those in the controls. The LES response to injection of the threshold volume was complete relaxation in both the PL patients and the controls. We conclude that the integrity of secondary esophageal peristalsis is preserved in PL patients.

Effect of maturation of the magnitude of mechanosensitive and chemosensitive reflexes in the premature human esophagus

“…17,19 Briefly, all studies were done in supine position using an infant-sized appropriate manometry catheter. After the infant was allowed to adapt to the catheter systems, the volume escalation protocol was performed in the same order for both studies: (1) air; (2) sterile water; and (3) apple juice.…”

Comparative study of salivary pH and volume in adults with chronic laryngopharyngitis by gastroesophageal reflux disease before and after treatment

“…In the last 12 years, many investigators and clinicians have proposed an association between Gastroesophageal Reflux Disease (GERD) and chronic laryngitis, the later representing the clinical form of the disease called Laryngopharyngeal Reflux (LPR) 1 , 2 , 3 , 4 , 8 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 . The larynx findings in cases of reflux laryngitis vary according to the case severity, it goes from hyperemia and mild edema of the larynx posterior third to severe cases of contact ulcers in the vocal process, exuberant scar tissue, larynx lining alterations, subglotic stenosis, even neoplastic degeneration of the epithelium 14 , 31 , 32 .…”

Estudo comparativo do pH e do volume salivar em indivíduos com laringofaringite crônica por doença do refluxo gastroesofágica antes e após o tratamento

“…It is believed that this great prevalence is due to a combination of a number of factors, from bad feeding habits and obesity 10,11 all the way down to genetic factors 9 . In the last 12 years, many investigators and clinicians have proposed an association between Gastroesophageal Reflux Disease (GERD) and chronic laryngitis, the later representing the clinical form of the disease called Laryngopharyngeal Reflux (LPR) [1][2][3][4]8,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] . The larynx findings in cases of reflux laryngitis vary according to the case severity, it goes from hyperemia and mild edema of the larynx posterior third to severe cases of contact ulcers in the vocal process, exuberant scar tissue, larynx lining alterations, subglotic stenosis, even neoplastic degeneration of the epithelium 14,31,32 .…”