Pharyngeal wall motion in the feline model-evidence of peristalsis

October 1992

ABSTRACTS OF PAPERS

1409

THREE DIMENSIONAL MODELING OF THE PHARYNGEAL CIRCADIAN -GEALIWl”ORFUI’I~ONMACRALASU PUMP DURING LIQUID SWALLOWS. H.J. B.P. Eypwh, T.R. Dclilssster. Depb of Sugay, Univnsity of PJ S Lin, GA Ergun, F Facchini, JA Logemann Depts of &nlthernCeli~rnie, Lo8 &geIca, Ce and TU M&, Germany. Medicine &‘Com Sci &Disorders, Northwestern University, Chicago. Apai8teleIeofthesrophyealbodyen&mdmdaophagatmmmm~besbeen During oropharyngcal swallow, the tongue and pharyngeal walls suggestedu the mejo?dkgwtlc featureof lwhelmii. utdng the Dewly developed form a piston-like chamber and then contract in unison to expel the techniqueof m&dewy 24-hour CsopBegeelmotility mo0it0ringwe eveluetcdthe contents of that chamber through the upper esophageal sphincter. This circadie erophyal motor petter0 in 14 petient.9with cl&c echelesia. On study investigated dynamic changes in the volume of the pharyngeal stendmd mmlomctrynone of the petienb bed any peristeltic c0nhaction of the chamber during swallows of graded volume. Methods: Synchronized Hophegeal body following 10 wet swenowa, 10 psItientsbed ee inmased lower PA and lateral biplane videofluoroscopic images of the oropharyngeal esophrgal sphincter &Es) prewll& all h&dinwmplete relexetion of the LJZS. cavity were obtained on 8 normal subjects during 1, 5, 10 8~ 20 ml Ambulet0ry motility dete were assgned scpamtely for the sleep (supine). liquid barium swallows. Videotapes were digitized and both PA & interdiive upright, end meal periods. lateral dimensions of the pharyngeal propulsive chamber were l&g&& Two of the 14 pntlentashowed no c0ntmctionsin the ceophegcel body measured at 1/3Otbs intervals along 8 axes defined by equiangular rays thmughoutthe 24-hourmonitoring period. Ihe circedie caophegmlmotorpattern emanating from the tongue center. Time 0 was the time of tongue to in the reamin@ 12 patieatais shown Ie the table. The @ency of esophegcal palate contact in the region of Passavant’s cushion. Pharyngeal c0ntmctio~ incrtlsrd from the supine t0 the upright to the meal periods chamber volume (PV) was modeled at 1/3Oth s intervals assuming @CO.OOl). In 3 petbt more the0 10% of all recorded c0ntmctions were ellipsoidal contours between measured PA and lateral dimensions and periBteltic,elkother4 @iaH.9 bad buwen 5% and 10% peristeltic co&ectio0s. using measured axial dimensions. Besulrs: The maximal PV achieved The perbteltic contractions(Iccumd primarily during the interdigestiveperiod, increased with bolus volume but the dynamics of the phatyngeal cycle i.e. during supine end uprightmonltorhig.Mean baselii pressure, contraction varied little in that the time of maximal chamber volume (PV max time), amplitude,and frcqueocyof contrections > 3OmmHg wen significantlyhigher the rate of maximal expulsion (max dV/dt PV), and the time of max during meals lls comparedto the interdigestiveperiods @3Ommhg 12.78_?3.81+ 2.12k2.01 3.37k2.93 Bwli0eprcwue Mean amplitudeof contractions: 37.87+5.O2 37.59+2x3 47.98+5.35* 5cmabovcLES 31.65k5.18 29.83k2.45 39.54+5.98* 10 cm eb0ve LIB Mtan dmation of contractions: 5 cm above LES 2.6a*o.25 3.13kO.21 2.86kO.47 Conclusions: The dynamics of-pharyngeal pump action during swallow 3.67kO.46 3.34LO.72 10 cm above LES 2.94kO.33 are remarkably constant among bolus volumes. The mechanics of the -___-----~~~_~~_~___-------~~~~~~-~-----------~~-_____~~~~~~~~~~~_______~~_~~~~~~~~~_____~~~~~~-pump are such that it is “tuned” to exert maximal force on larger *: p < 0.01 vs supine and upright;$: p < 0.01 vs supine boluses and impart progressively lesser force on smaller boluses. m A substantielmunber of ptients thoughtto heve apristalsis of the Differences in ejection characteristics among bolus volumes result from csoph;lsal b0dy besed on ntanderdnunometry Bhowperistekic c0ntmctio~ when the discrepancy between optimal volume for the pump and actual bolus motor timction is monitored over prolonged peri0dn. ‘IIds would suggest that volume. This relationship accounts for the increased ejection velocity lower eeophsrsal sphiackx dysfunction rcprwents the primary motor defect in and UES distension observed with larger volume liquid swallows. achelesia, followed by ape&&is LVI the disease progmwa.

PHARyN(IEAL WALL MOTlON IN THE FEUNE MODEL-MDENCE OF PERISTALSIS. M.K. Kerq R. Shaker, RD. Layman, W.J. Dodde. Mi Dyeptbwie InetiMe, Medkal coile@x4 ws., Mice, WI. Pkyngealbohstraqxntduriq~ewalfcwiqhesbeenetudii usingvadcuemanome&alldltuoroscopictechniqwshowevecthe fMeta& nature of thii tranqort hae been questbwd. Illstead of

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Two eets of small tantalum beade (4.14 cm dieme&) = eu@cany attached to the pheIynQeal well to etreddle the phplynx. Thedktafpakwaepoekionedettheupperme@noftheUESend thepmxhn&peirapp&natefyl CmabovetheUES. Markermovememfor dryewalbweanddkeebatiumewaHowewaemccfded mvideotapedwing A-P and lateral ffuoroscopy andanalyzedusirgacomputerl7.edvideo z%@&3ieeyetem. The average dietence from the proximal markers to the dlstel markers wae 0.92~0.05 cm meeeured flwrosco@My. Anak#s of videdluorosoopicrec&bgereveafedtbtheeteofmaMremcvedorad at the hit&ion of eech ewalfow. The average upvard rmxemem wes 0.120+0.010an(mean~SD)forthe~malmarkersand0.130i0.OWcmforthe dMal markers, tftus indk&i pharynseel shorteningof 0.010~0~006 cm. A!3theoncomfngbofueapproachedthephalymc,therfmrkeremoved elighHy apsl (0.07*0.O2cm), ‘engulfing’ the bob. The extent of this dUfemntfrcm the outwerd movement of berfum ewafk~. the markers as they moved toward the midfine was 6.19+0.31 cm/s. Fofbwingthepaeeageofthebolus,eachmerkerpeirapproximatedthe midlineinanoradtocaudadsequence. TheevemgequetMaforedto ceuded pqmgation velocfty was 21+2 cm/s. The entire pistaltic quence took place in 0.22*0.02 s. chn irMk@@i &lowed no eignifkentdMrencebetweenbariumanddryewalksinanyofthe me%wredy. Weccndudethetdegutatlvephqngeafconbaction inthecetieahighfquency,pedMticeventinwhfchthe~wall mcveeupwardattheinklet&nofaewalfcwandouruaMto*engulPtfw onwmingbobeaRerwhfcharapM,fMMticcontractionwaveuanqmts thebolueoutofthepf?erynx. Thepharynxshorteneandtflelerynxrapidly elevateedurfng~. The phasyn~eel wall outward thus widening the pharyngeal cavity before belts arrival.