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PubMed1997

Modified barium swallow does not affect how often PEGs are placed after stroke.

Dysphagia frequently follows stroke, but often resolves quickly. Percutaneous endoscopic gastrostomy (PEG) or other feeding tubes are placed to improve nutrition and hydration, and reduce the risk of aspiration pneumonitis. We evaluated the impact of modified barium swallow in determining PEG placements and the influence of specific swallowing abnormalities on PEG placement. The abnormalities assessed were presence of pharyngeal stasis and/or visualization of posterior pharyngeal transfer problems and aspiration of liquid or solids. A total of 302 patients with stroke were admitted to our hospital between 1989 and 1993, but only those with hemorrhagic or nonhemorrhagic stroke by computed tomographic (CT) scans or magnetic resonance imaging (MRI) or autopsy were included in our study. Patients with transient ischemic attacks (TIAs), central nervous system tumors, and traumas were excluded. Barium swallow studies were performed on 69 (23%) of patients; 49 (71%) were abnormal, based on aspiration of barium, pharyngeal stasis, or postpharyngeal transfer dysphagia. PEGs were placed in only 18% of those with abnormal studies. Of the patients with normal barium swallow studies, 25% had a PEG placed. Two hundred thirty-three patients underwent no barium swallow studies, but 11 (4.72%) of these had PEG placed. The rate of PEG placement was not related to any one of the abnormalities noted on the modified barium swallow. Rather, patients who received PEG had significant neurological deficits and increased prevalence of aspiration pneumonitis. The decision to insert PEG was made on clinical grounds and not on abnormal barium studies alone.

Aged↗
PubMed1999

Formal swallowing evaluation and therapy after traumatic brain injury improves dysphagia outcomes.

BACKGROUND: The incidence of swallowing dysfunction after brain injury is unknown. The efficacy of dysphagia therapy is also unknown. We reviewed our experience to define the incidence of swallowing dysfunction and efficacy of therapeutic intervention. METHODS: Patients with brain injury sustained between January of 1996 and December of 1997 were reviewed. All were screened with trials of oral intake. Abnormal findings were confirmed with a videofluoroscopic swallow study. Standard therapies included diet, posture, and behavior modifications. RESULTS: A total of 47 patients were evaluated. Bedside evaluations were normal in 14 patients, 2 patients had overt aspiration and underwent gastrostomy, and 31 patients were referred for a videofluoroscopic swallow study (66%). The videofluoroscopic swallow study was abnormal in 22 of 31 patients (71%). Of these, 4 additional patients required gastrostomy, 13 patients had laryngeal penetration or minor aspiration responsive to dysphagia therapy and were fed. Five other patients had silent aspiration and were fed by means of nasogastric tube; these five patients responded to dysphagia therapy and were able to resume oral intake. CONCLUSION: Dysphagia is common after severe head injury. With formal swallowing service intervention, aspiration is avoided. Therapeutic interventions can be used to restore oral intake.

Adolescent↗
PubMed2001

Functional magnetic resonance imaging of the pediatric swallow: imaging the cortex and the brainstem.

OBJECTIVE: To design and implement a functional magnetic resonance imaging (fMRI) protocol to investigate the cortical and brainstem patterns of activity in children with regard to the act of swallowing. STUDY DESIGN: Pilot study to assess the clinical feasibility of the project. METHODS: Using a 3T Bruker Biospec 30/60 MRI scanner, images were obtained using the Behavior Interleaved Gradient/Blood Oxygen Level Dependent (BIG-BOLD) image acquisition method. Initially, regions of interest (ROI) were developed to identify the mean time from the onset of a swallow to maximum cortical blood flow in the motor cortex. Using this data to design the BIG-BOLD acquisition method followed by postprocessing of the data, images from two volunteer adults and four volunteer children were obtained. RESULTS: The average time from the onset of a swallow to maximum cortical blood flow was 6 to 8 seconds. Regions of cortical activity include pre- and post-central gyrus (Brodmann's areas 3 and 4), superior motor cortex (B.A. 24), insula, inferior frontal cortex (B.A. 44 and 45), Heschl gyrus (B.A. 41 and 42), putamen, globus pallidus, and the superior temporal gyrus (B.A. 38). Of particular note is the first mapping of the functional activity of swallowing at the level of the brainstem; activity was seen in the region of the nucleus ambiguous. CONCLUSIONS: fMRI provides a novel means of studying the central processes of both normal swallowing and its various pathologic forms in children. Further understanding of how a child coordinates a swallow and how this coordination can be altered at the level of the brainstem and cortex may aid in the development of novel rehabilitative strategies.

Adolescent↗
PubMed2002

Oropharyngeal swallowing variability.

OBJECTIVES/HYPOTHESIS: The pharyngeal phase of deglutition is considered to occur in a reflexive, preprogrammed fashion. Previous studies have determined a general sequence of events based on the mean timing of bolus transit and swallowing gestures. However, individual variability has not been studied. The purpose of the present study was to evaluate the amount of sequence variability that normally occurs during the oropharyngeal phase of deglutition. STUDY DESIGN: Prospective analysis of conservative subjects. METHODS: Dynamic swallow studies from 60 normal volunteers were evaluated, and event sequence variability was determined around two event sequences during swallowing of three bolus sizes. RESULTS: There was found to be substantial variability in event sequences for all events analyzed. Variability was greater during a smaller bolus swallow. CONCLUSIONS: The evaluation of variability within the study group of individuals reveals the complexity of the swallowing mechanism and underscores the importance of not relying on general guidelines in evaluating the coordination of swallowing gestures in a given individual with dysphagia complaints.

Adult↗
PubMed2003

Videofluoroscopic swallow studies in unilateral cricopharyngeal dysfunction.

OBJECTIVES/HYPOTHESIS: Although the cricopharyngeus muscle is a ring-like structure, unilateral cricopharyngeal dysfunction can produce significant dysphagia. This entity has not been well described in the literature. The aims of the study were to identify the characteristic findings on videofluoroscopic swallow studies in patients with dysphagia secondary to unilateral cricopharyngeal dysfunction, to note the associated vagal nerve injury, and to evaluate patient outcomes following ipsilateral cricopharyngeal myotomy. STUDY DESIGN: Retrospective clinical investigation. METHODS: The clinic charts, electromyographic tests, videostroboscopic examinations, and videofluoroscopic swallow studies were reviewed from a series of patients who presented to our institution from 1993 to 2001 with dysphagia and findings on videofluoroscopic swallow studies suggestive of unilateral cricopharyngeal dysfunction on posterior-anterior view. In patients treated with ipsilateral cricopharyngeal myotomy, postoperative findings on swallow studies and patient outcomes were also reviewed. RESULTS: Eighteen patients demonstrated findings characteristic of unilateral cricopharyngeal muscle dysfunction on videofluoroscopic swallow study. The common feature was a unilateral shelf-like barrier at the cricopharyngeus on the posterior-anterior view with pooling of liquid bolus in the ipsilateral pyriform sinus and episodic shunting to the contralateral side. Eight patients did not have evidence of cricopharyngeal dysfunction (ie, cricopharyngeal bar) on lateral films. Of the 18 patients, 14 had histories consistent with vagal injury secondary to trauma (n = 2), neoplastic involvement (n = 7), iatrogenic injury (n = 2), or central nervous system disease (n = 3). Results of videostroboscopic examinations demonstrated vocal fold motion impairment in 14 patients, and electromyographic test results confirmed unilateral vagal injuries in those who underwent electromyographic testing (n = 6). In the remaining 4 of 18 patients, videostroboscopic examinations demonstrated normal vocal fold abduction but impaired lengthening with a posterior glottic gap, and electromyographic test results (n = 4) indicated unilateral superior laryngeal nerve involvement. Of the 15 patients treated with ipsilateral cricopharyngeal myotomy, 1 patient required postoperative esophageal dilations for an esophageal stricture distal to the cricopharyngeus, whereas the remaining 14 patients had functional resolution of their dysphagia. CONCLUSION: In patients presenting with dysphagia and evidence of unilateral vagal injury, careful assessment of posterior-anterior view on videofluoroscopic swallow study should be included to evaluate for unilateral cricopharyngeal dysfunction.

Adult↗
PubMed2006

Evaluation of patients with globus pharyngeus with barium swallow pharyngoesophagography.

OBJECTIVE: The objective of this study was to determine the value of barium swallow pharyngoesophagography in the investigation of patients with globus pharyngeus who had no known disease, no operation history in the head and neck region, and no thyroid pathology. We compare the clinical presentation with the radiologic findings to assess the diagnostic accuracy of barium swallow in such patients. METHODS: This was a retrospective study of the clinical records and radiologic reports of 194 patients with globus pharyngeus, between October 1998 and October 2004, that were reviewed and analyzed for correlations between clinical signs and symptoms and barium swallow findings using the chi2 test. All the patients had normal ear, nose, and throat examination, including indirect laryngoscopy and/or nasoendoscopy. Patients with known pharyngeal and esophageal disease, neurologic disease known to cause pharyngeal or esophageal dysfunction, evidence of autoimmune disease or diabetes mellitus, with a thyroid operation in the past and thyroid nodules detected with radiologic investigation were excluded. RESULTS: There were 116 (59.8%) female and 78 (40.2%) male patients. In 114 patients (59%), globus was the only symptom. Sore throat was the most common associated complaint. Benign barium swallow findings were detected in 63.9% of the patients. Cervical osteophyte indentation was the most common finding. In 36.1% of the patients, the radiologic finding was normal. The statistical analysis using the chi2 test showed a significant relationship (P < .001) between the symptoms of globus pharyngeus and the barium swallow results. CONCLUSION: Barium swallow pharyngoesophagography is useful to detect underlying benign characteristic pathologies in patients with globus who have no known head and neck illness.

Adult↗
PubMed1988

Molecular analysis of the swallow gene of Drosophila melanogaster.

We report the cloning and molecular characterization of the swallow gene, a maternal-effect gene of Drosophila melanogaster. Maternal-effect genes are transcribed only during oogenesis; one such gene, bicoid, encodes a message that is localized at the anterior end of oocytes, eggs, and early embryos. swallow+ activity is necessary during oogenesis for bicoid message localization. We show here that a fragment of a previously identified clone, introduced into the genome by P-element-mediated transformation, is able to rescue the maternal-effect lethality of swallow mutants, confirming the identity of this clone as swallow. By in situ hybridization, we show that swallow message is synthesized in nurse cells during oogenesis but is not localized along either the anterior-posterior or dorsal-ventral axes. We have confirmed an earlier finding that the localization of bicoid message is defective in swallow- oocytes and eggs.

Animals↗
PubMed2004

Classification of normal and dysphagic swallows by acoustical means.

This paper proposes a noninvasive, acoustic-based method to differentiate between individuals with and without dysphagia or swallowing dysfunction. Swallowing sound signals, both normal and abnormal (i.e., at risk of some degree of dysphagia) were recorded with accelerometers over the trachea. Segmentation based on waveform dimension trajectory (a distance-based technique) was developed to segment the nonstationary swallowing sound signals. Two characteristic sections emerged, Opening and Transmission, and 24 characteristic features were extracted and subsequently reduced via discriminant analysis. A discriminant algorithm was also employed for classification, with the system trained and tested using the leave-one-out approach. Overall, 350 signals were used from three bolus consistencies (semisolid, thick and thin liquids). A final screening algorithm correctly classified 13 of 15 control subjects and 11 of 11 subjects with some degree of dysphagia and/or neurological impairments. The proposed method has great potential to reduce the need for videofluoroscopic swallowing studies (the current gold standard method for swallowing assessment, which is invasive and nonportable) and to assist in the overall clinical assessment of swallowing sound signals.

Adolescent↗
PubMed2006

Questionnaire analysis of the swallowing-related outcomes following total laryngectomy.

OBJECTIVE: To determine the effects of a total laryngectomy on the swallow and subsequent quality of life in head and neck cancer patients. DESIGN: Cross-sectional single centre cohort study. SETTING: Head and Neck Oncology Unit, Tertiary Referral Unit. PATIENTS: Sixty-two patients who underwent total laryngectomy at our centre participated in the study. METHODS: Subjects were stratified by age, sex, tumour stage, other procedures such as myotomy and nerve re-implantation. Pharyngectomy, glossectomy, flap reconstruction, neck dissection and previous radio- and chemotherapy were also assessed to see if they affected swallow and subsequent quality of life. Main outcome was measured using the MD Anderson Dysphagia Inventory questionnaire. RESULTS: Responses were received from 46 males and 16 females (response rate of 80.5%) with a mean age of 64.7 years (SD 9.4). Median follow-up in patients was 90 months (range 1-276). The mean MD Anderson Dysphagia Inventory total score in our series of patients was 77.7 (SD 16.6). MD Anderson Dysphagia Inventory global score was 79.4 (SD 22.6), Emotional score was 77.7 (SD 17.8), Functional score 81.3 (SD 15.9) and Physical score was 74.1(SD 18). Statistically significant differences were seen between the emotional scores of glossectomised and non-glossectomised patients (Mann Whitney, P = 0.04). No significant correlation was seen between the subscale scores and the remaining treatment variables such as age, gender, site, tumour stage, myotomy, nerve implantation, radiotherapy, reconstruction and major complications. CONCLUSION: This questionnaire study is the largest of its type to assess the swallow of patients who have undergone laryngectomy at a single centre. The overall result confirmed that most patients had a subjectively good swallow. Only glossectomy and the method of PE segment closure were shown to significantly affect swallowing outcomes following surgery. We recommend further work especially prospective studies pre and post surgery using this or similarly validated instruments to fully assess swallow in the laryngectomy population.

Adult↗
PubMed1994

Midazolam/propofol but not propofol alone reversibly depress the swallowing reflex.

General anaesthetics depress swallowing and this is a reason to delay oral intake after general anaesthesia. The swallowing reflex was studied 2 h after general anaesthesia for patients undergoing colonoscopy. Forty-one patients were anaesthetized with midazolam 75 micrograms.kg-1 followed by a continuous infusion of propofol and 39 patients with propofol 1.5 mg.kg-1 bolus followed by an infusion. Swallowing reflex was measured by electromyography 2 h after induction of anaesthesia, before and 5 min after the administration of flumazenil (0.2 mg) or placebo. Two h after anaesthesia, the state of consciousness was almost normal in all patients and did not change after flumazenil. At two hours, the latency times for the swallowing reflex in patients treated with propofol alone were of 1.4 +/- 0.4 s and were significantly shorter (P < 0.05) than the value of 1.9 +/- 0.8 s observed in patients who received midazolam with propofol. In the latter group the latency time of the swallowing reflex was significantly reduced following the administration of flumazenil but not placebo. In patients who received propofol without midazolam, the administration of flumazenil or placebo was not associated with significant changes in the latency times. There were also no significant differences in the latency times in the subgroup that received midazolam followed by flumazenil and the propofol alone groups that did or did not receive flumazenil. These results suggest that midazolam still exerts a depressive effect on the swallowing reflex 2 h after its administration despite the recovery of normal consciousness.

Ambulatory Care↗
PubMed2005

The effects of lingual exercise on swallowing in older adults.

OBJECTIVES: To determine the effects of an 8-week progressive lingual resistance exercise program on swallowing in older individuals, the most "at risk" group for dysphagia. DESIGN: Prospective cohort intervention study. SETTING: Subjects were recruited from the community at large. PARTICIPANTS: Ten healthy men and women aged 70 to 89. INTERVENTION: Each subject performed an 8-week lingual resistance exercise program consisting of compressing an air-filled bulb between the tongue and hard palate. MEASUREMENTS: At baseline and Week 8, each subject completed a videofluoroscopic swallowing evaluation for kinematic and bolus flow assessment of swallowing. Swallowing pressures and isometric pressures were collected at baseline and Weeks 2, 4, and 6. Four of the subjects also underwent oral magnetic resonance imaging (MRI) to measure lingual volume. RESULTS: All subjects significantly increased their isometric and swallowing pressures. All subjects who had the MRI demonstrated increased lingual volume of an average of 5.1%. CONCLUSION: The findings indicate that lingual resistance exercise is promising not only for preventing dysphagia due to sarcopenia, but also as a treatment strategy for patients with lingual weakness and swallowing disability due to frailty or other age-related conditions. The potential effect of lingual exercise on reducing dysphagia-related comorbidities (pneumonia, malnutrition, and dehydration) and healthcare costs while improving quality of life is encouraging.

Aged↗
PubMed2003

Effect of different swallow time intervals on the nutcracker esophagus.

OBJECTIVE: Nutcracker esophagus (NE) is defined as the presence of peristaltic contractions in which the average distal esophageal amplitude is greater than 180 mm Hg. The underlying mechanism responsible for these abnormalities is not known. The aim of this study was to test the hypothesis that NE might be caused by a defect in the inhibitory pathway controlling esophageal peristalsis. METHODS: Eight patients with NE (seven women, 1 man, mean age 50 yr) and eight age- and sex-matched normal volunteers (seven women, 1 man, mean age 48 yr) underwent a special protocol using three-channel (3, 8, and 16 cm above the lower esophageal sphincter) solid state esophageal manometry to evaluate deglutitive inhibition. Ten pairs of 5 ml of wet swallows were given at each of five different time intervals (30, 20, 15, 10, and 5 s). Pairs of swallows were spaced by 30 s, and different time intervals were spaced by 1 min. Tracings were recorded using a computer program and blindly automatically analyzed for both amplitude and duration of the contraction separately for the first and second swallow of each pair. Presence of deglutitive inhibition or muscle refractoriness was assessed according to interactions between the first and second swallow of the pair. Results were found abnormal when larger than the mean percent variation of the second and first swallow calculated for the 30-s interval, considered as baseline for each participant. Statistics included paired and nonpaired nonparametrical comparisons as appropriate. RESULTS: The median amplitude for the NE was 202 mm Hg (range 186-376) and for the controls was 118 mm Hg (range 64-167) (p = 0.0002). The median duration in the NE group was 5.1 s (range 4-9.3) versus 4.1 (range 3.3-5.0) for the controls (p = 0.02). The percent variation in duration (p = 0.31), amplitude (p = 0.42), and propagation velocity of the peristaltic waves (p = 0.69) did not differ between the control and NE groups. Peristalsis frequency dropped at the 5-s interval for both studied groups (p = 0.84). CONCLUSION: Central and local inhibitory mechanisms induced by closely timed swallows are preserved in the NE and do not explain the mechanism of the high amplitude and long duration contractions.

Adult↗
PubMed2004

Swallowing thresholds of mandibular implant-retained overdentures with variable portion sizes.

We analysed the effect of three portion sizes Optocal Plus (small, medium and large) on swallowing thresholds in subjects with either conventional complete dentures or mandibular implant-retained overdentures (transmandibular and permucosal cylindric implants). Tests were carried out in 52 women and 15 men (mean age 59 years) 4 years after treatment in a randomised controlled clinical trial. The results indicated that the degree of mucosal support for the mandibular denture did not affect the number of chewing strokes, time till swallowing or swallowed particle size. Only the chewing rate differed: subjects wearing mandibular implant-retained overdentures chewed the food at a higher rate than complete-denture wearers. With larger portion sizes, subjects needed significantly more chewing strokes and time until swallowing and they would have swallowed larger particles. Men chewed their food more efficiently than women, as they used the same number of chewing strokes and time, but achieved a greater particle size reduction at the swallowing moment.

Adult↗
PubMed2002

Difference between hypoglossal and phrenic activities during lung inflation and swallowing in the rat.

We aimed in this study to elucidate the discharge properties and neuronal mechanisms of the dissociation between hypoglossal and phrenic inspiratory activities in decerebrate rats, which had been subjected to neuromuscular blockade and artificially ventilated. The discharge of the hypoglossal nerve and the intracellular activity of hypoglossal motoneurones were monitored during respiration and fictive-swallowing evoked by electrical stimulation of the superior laryngeal nerve, and were compared with the activity of the phrenic nerve. The hypoglossal nerve activity was characterized by its onset preceding the phrenic nerve activity ('pre-I' activity). By manipulating artificial respiration, we could augment the 'pre-I' activity, and could elicit another type of hypoglossal activity decoupled from the phrenic-associated inspiratory bursts ('decoupled' activity). We further scrutinized the correlatives of 'pre-I' and 'decoupled' activities in individual hypoglossal motoneurones. Hypoglossal motoneurones consisted of inspiratory (n = 42), expiratory (n = 18) and non-respiratory (n = 1) neurones and were classified by their swallowing activity into depolarized, hyperpolarized, hyperpolarized-depolarized and unresponsive groups. All of the inspiratory neurones were depolarized in accordance with the 'pre-I' and 'decoupled' activities, and all of the expiratory neurones were hyperpolarized during these activities. Fictive swallowing, which was characterized by its frequent emergence just after the phrenic inspiratory activity, was also evoked just after the 'decoupled' hypoglossal activity, suggesting that this activity may have similar effects on swallowing as the 'overt' inspiratory activity. Such a coupling between 'decoupled' and swallowing activities was also revealed in each motoneurone. These findings suggest that the 'pre-I' and 'decoupled' activities may reflect some internal inspiratory activity of the respiratory centre and that hypoglossal motoneurones may be driven by a distinct group of premotor neurones that possibly play a role in the coordination of respiration and swallowing.

Animals↗
PubMed1999

Metal detector and swallowed metal foreign bodies in children.

OBJECTIVE: To evaluate a metal detector to diagnose swallowed radio-opaque metal foreign bodies (MFBs) in children, and whether they can detect non-radio-opaque MFBs. METHODS: In a prospective study, 231 children, who presented to the accident and emergency department with a history of swallowing MFBs, were evaluated by the metal detector as well as radiography to confirm and locate the presence or absence of MFBs. RESULTS: A definite history of swallowing a MFB by the child was given by 186 (81%) parents. The metal detector located MFBs in 183 children and radiographs confirmed radio-opaque MFBs in 181. In the remaining 45 (19%), when swallowing was suspected and not definite, both metal detector and radiography confirmed the presence of a MFB in only four. CONCLUSION: A high detection rate of swallowed MFBs was observed in this study, using a metal detector. It is also of value to detect non-radio-opaque MFBs like aluminium. The detection of MFBs is high when the history of swallowing is definite.

Child↗
PubMed1997

Response of parkinsonian swallowing dysfunction to dopaminergic stimulation.

OBJECTIVES: To determine the degree of dopaminergic response of swallowing dysfunction in Parkinson's disease. METHODS: Fifteen patients with idiopathic Parkinson's disease and symptomatic dysphagia were studied. All had motor fluctuations in response to long term levodopa therapy. On two separate days, after overnight withdrawal of all antiparkinsonian medication, a modified barium swallow using cinefluoroscopy and different food consistencies was performed before and after administration of oral levodopa and subcutaneous apomorphine. RESULTS: Despite all patients having an unequivocal motor response to both agents, there were few significant responses in any of the quantitative or qualitative criteria of swallowing dysfunction assessed. The oral preparatory phase, generally considered a more voluntary component of swallowing, showed a response, but not with all consistencies. In a subgroup of patients the pharyngeal phase time also improved. CONCLUSIONS: These findings suggest that parkinsonian swallowing dysfunction is not solely related to nigrostriatal dopamine deficiency and may be due to an additional non-dopamine related disturbance of the central pattern generator for swallowing in the pedunculopontine nucleus or related structures in the medulla.

Aged↗
PubMed2003

Changes in pharyngeal corticobulbar excitability and swallowing behavior after oral stimulation.

Faucial pillar (FP) stimulation is commonly used in swallowing rehabilitation, yet its physiological basis remains uncertain. We investigated the effects of intraoral FP stimulation on human corticobulbar excitability and swallowing behavior, to explore the possibility of a central mechanism for functional change. In 10 healthy subjects, corticobulbar projections to pharynx were investigated with transcranial magnetic stimulation, via intraluminal electrodes, before and up to 1 h after 10 min of electrical FP stimulation with three frequencies (0.2, 1, and 5 Hz) or sham and peripheral (median nerve) stimulation. In a second study, swallowing behavior was assessed with videofluoroscopy before and after FP stimulation. FP stimulation at 5 Hz inhibited the corticobulbar projection (-14 +/- 6%, P < 0.02) and lengthened swallow response time (+114 +/- 24%, P = 0.02). By comparison, FP stimulation at 0.2 Hz facilitated this projection (+60 +/- 28%, P < 0.04), without enhancing swallowing behavior. Neither 1-Hz, sham, nor median nerve stimulation altered excitability. Thus changes in corticobulbar excitability to FP stimulation are frequency dependent with implications for the treatment for neurogenic swallowing dysfunction.

Adult↗
PubMed1980

Effect of time interval between swallows on esophageal peristalsis.

Esophageal peristaltic pressure amplitude, peristaltic incidence, speed of peristalsis, and wave duration were investigated as a function of swallow interval. In the distal half of the esophagus, the amplitude decreased at swallow intervals of 8 s and shorter. At intervals of 8 and 4 s, dropouts of contractions that were obtained were most frequent in the distal esophagus and for the 4-s interval. At continuous swallows no contractions were obtained below the upper esophageal sphincter until the end of the swallow sequence, after which a peristaltic wave of high amplitude propagated along the esophagus. The peristaltic speed increased toward a level 5 cm above the lower esophageal sphincter. The peristaltic wave duration was approximately the same in different parts of the esophagus and at different swallow intervals. The findings indicate an impairment of esophageal transport function by short swallow intervals.

Adult↗