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[Dysphagia] UES/Reflux query
acellucc@bidmc.harvard.edu wrote:
We'd mentioned our question to a GI doc/resident who didn't seem to think there could be a relationship between the two b/c of the fact that the top 1/3 is striated muscle vs lower 2/3 smooth muscle and that were was no shared relationship between nerve pathways of UES/LES, but I still seem to have a hard time seeing how these could be happening independently of each other, as though they exist in a vacuum or don't influence one another.
*****There is considerable agreement that high GER can and does cause cervical deglutition dysfunction. The cricopharyngeal bar and CP achalasia, when not caused by proven neurological failure have been related to high GER. In addition, your informant should check the neurophysiology of swallowing and the digestive tract.
Go to
www.gastroatlas.com
Register (free) then go to Chap 1: Neurophysiology of swallowing.
The diagram shows the ventral portion within the medulla that appears to serve as a connecting pathway to the various motor neuron pools involved in the swallowing sequence, such as integration of the swallowing sequence with the respiratory center as well as neurons that link the pharyngeal and esophageal phases of the swallow.The dorsal motor nuclei of the vagus serve esophageal smooth muscle with some added input to striated muscle. The UES is innervated by the RLN(vagus) as well as the pharyngeal plexus so that the vagus and its divisions are serving related structures. See: Castell DO, In The Esophagus. Edited by Castell DO. Boston: Little, Brown, and Co; 1995 1-29
Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com
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