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PubMed2005

Radiofrequency catheter ablation therapy of swallowing-induced atrioventricular nodal reentrant tachycardia: report of two cases.

We describe two patients who presented with a history of recurrent palpitations on swallowing of solid food. The event-recorder and Holter monitoring documented episodic supraventricular tachycardia (SVT) initiated by atrial premature contractions (APCs). During electrophysiological study (EPS), swallowing of solid food consistently induced APCs and their activation sequence, morphology of P wave were suggestive of their right atrial origin in them. Drug challenge did not affect the APC onset during the swallowing. During EPS, slow-fast variety of atrioventricular nodal reentrant tachycardia (AVNRT) was induced and successful radiofrequency (RF) catheter ablation of slow pathway resulted in total relief of their symptoms.

Catheter Ablation↗
PubMed2005

Curative therapy for swallowing-induced tachycardia by pulmonary vein antrum isolation.

We present a case of a 49-year-old man who experienced invariably reproducible paroxysmal supraventricular tachycardia during swallowing. Because beta-blockers and multiple antiarrhythmic drugs failed to prevent the episodes of this tachycardia, we performed catheter mapping and ablation. After placing multiple decapolar catheters, when the patient swallowed a few sections of an orange, intracardiac mapping revealed atrial premature beats and atrial tachycardia that lasted for a few seconds and arose from an ostial site of the right superior pulmonary vein. After the right superior pulmonary vein antrum was completely isolated, the patient became free from the swallowing-induced tachycardia.

Adrenergic beta-Antagonists↗
PubMed1987

Motor loss and swallowing difficulty after stroke: frequency, recovery, and prognosis.

Data relating to motor loss and swallowing difficulties in a community sample of 976 patients who suffered an acute stroke have been analysed. About 17% of patients seen within one week had no paralysis; at 6 months 48% of survivors had no paralysis and 9% had severe paralysis. The Motricity Index used to study motor loss related to functional loss and walking ability; it seems to be a simple valid measure of motor loss. Severe paralysis was associated with a high fatality rate, and only 6%-10% of survivors of an initially severe paralysis made a full recovery by 6 months. If severe persisted at 3 weeks, full recovery was not observed. Loss of sitting balance was associated with a poor outcome. Of conscious patients seen within one week, 14% choked on attempting to swallow and a further 28% had abnormal swallowing: this 42% of patients had a high fatality rate.

Activities of Daily Living↗
PubMed2006

Fibreoptic endoscopic evaluation of swallowing and videofluoroscopy: does examination type influence perception of pharyngeal residue severity?

OBJECTIVES: The aim of the study was to investigate whether the type of instrumental swallowing examination (Fibreoptic Endoscopic Evaluation of Swallowing (FEES) or videofluoroscopy) influences perception of post-swallow pharyngeal residue. DESIGN: Prospective, single-blind assessment of residue from simultaneous videofluoroscopy and FEES recordings. All raters were blind to participant details, to the pairing of the videofluoroscopy and FEES examinations and to the other raters' scores. SETTING: Tertiary specialist ENT teaching hospital. PARTICIPANTS: Fifteen adult participants consecutively recruited; seven women and eight men aged between 22 and 73, mean age 53. All participants underwent one FEES examination and one videofluoroscopy examination performed simultaneously. INCLUSION CRITERIA: referred to speech and language therapy for assessment of dysphagia. EXCLUSION CRITERIA: nil by mouth or judged to be at high risk of aspiration. MAIN OUTCOME MEASURES: The FEES and videofluoroscopy examinations were recorded simultaneously. Fifteen speech and language therapists independently scored pharyngeal residue as none, coating, mild, moderate or severe. All examinations were scored twice by all raters. RESULTS: Intra- and inter-rater agreement were similar for both examinations. There were significant differences between FEES and videofluoroscopy pharyngeal residue severity scores (anova, P < 0.001). FEES residue scores were consistently higher than videofluoroscopy residue scores. CONCLUSIONS: Pharyngeal residue was consistently perceived to be greater from FEES than from videofluoroscopy. These findings have significant clinical implications as FEES and videofluoroscopy findings are used to judge aspiration risk and to make recommendations for oral intake. Further research is required to examine the impact of FEES and videofluoroscopy examinations on treatment decisions.

Adult↗
PubMed1995

A denture swallowed. Case report.

Swallowing and aspiration of dental foreign objects is often reported in the literature. Swallowing seems to be more common than aspiration, and is observed most often in the elderly. Too often the size and configuration of these objects compounds their impaction and removal. A 67-year-old man swallowed a unilateral removable partial denture which became lodged in his mid-oesophagus. The denture was located by radiographic examination of his chest and removal by a rigid oesophagoscopy was performed under general anaesthetic.

Aged↗
PubMed1983

Manometric and electromyographic observations of the oesophagus of sheep in eructation, regurgitation and swallowing.

Manometric and electromyographic recordings during eructation, swallowing and the regurgitation of rumination in sheep revealed variable oesophageal activity during eructation in contrast to the uniform pattern of oesophageal activity in swallowing and regurgitation. In eructation the passive increase in pressure of about 7-15 mmHg--the filling phase--associated with entry of gas into the oesophagus was commonly (in 96.6% of thirty eructations) terminated by contractions in the caudal thoracic oesophagus (c.t.o.). Eructation contractions were present in 73.3% of thirty eructations in a site 130 mm cranial to the c.t.o. and in 36.6% of thirty eructations in a site 260 mm cranial to the c.t.o. These contractions moved cranially at about 420 mm.s-1. In contrast during regurgitation the contractions of the oesophagus which moved cranially at about the same rate (410 mm X s-1) were characteristically more intense (47-64 mmHg) than eructation contractions (10-36 mmHg). Also in contrast to those in eructation, regurgitation contractions were invariably of each site of the oesophagus from which recordings were made. Secondary contractions of the caudal cervical and thoracic oesophagus which sometimes followed eructation were interpreted as serving as clearing contractions returning residual gas in the oesophagus to the stomach. These swept over the oesophagus at about 200 mm X s-1 and occurred without associated swallows. The variability of reactions of the oesophagus in eructation and differences in reactions of its different regions are discussed as arising from different degrees of sensitivity to, and stimulation by, gaseous distension of the oesophagus and stomach.

Animals↗
PubMed2003

Tongue-surface movement patterns during speech and swallowing.

The tongue has been frequently characterized as being composed of several functionally independent articulators. The question of functional regionality within the tongue was examined by quantifying the strength of coupling among four different tongue locations across a large number of consonantal contexts and participants. Tongue behavior during swallowing was also described. Vertical displacements of pellets affixed to the tongue were extracted from the x-ray microbeam database. Forty-six participants recited 20 vowel-consonant-vowel (VCV) combinations and swallowed 10 ccs of water. Tongue-surface movement patterns were quantitatively described by computing the covariance between the vertical time-histories of all possible pellet pairs. Phonemic differentiation in vertical tongue motions was observed as coupling varied predictably across pellet pairs with place of articulation. Moreover, tongue displacements for speech and swallowing clustered into distinct groups based on their coupling profiles. Functional independence of anterior tongue regions was evidenced by a wide range of movement coupling relations between anterior tongue pellets. The strengths and weaknesses of the covariance-based analysis for characterizing tongue movement are considered.

Adolescent↗
PubMed1973

Swallowing in fetal sheep.

Swallowing was measured in fetal sheep by using electromagnetic flowmeter heads chronically implanted in the fetal esophagus. The fetus swallows 20 to 200 milliliters of amniotic fluid in two to seven discrete episodes per day. The episodes are 1 to 9 minutes in duration and occur at seemingly random intervals. Swallowing is influenced by the condition of the fetus and may be the first manifestation of eating and drinking behavior.

Amniotic Fluid↗
PubMed1985

Comparison of barium swallow and ultrasound in diagnosis of gastro-oesophageal reflux in children.

Fifty one infants and older children with suspected gastro-oesophageal reflux entered a study comparing the diagnostic accuracy of a standard barium swallow examination with that of ultrasound scanning. All children were examined by both techniques. In 40 cases there was unequivocal agreement between the examinations. Of the remaining patients, four had definite reflux by ultrasonic criteria but showed no evidence of reflux on barium swallow examination, four had positive findings on ultrasound but showed only minimal reflux on barium swallow, and one showed minimal reflux on ultrasound but had a negative barium meal result. In two children the ultrasound study was inconclusive. Ultrasound has an important role in the diagnosis and follow up of patients under the age of 5 years with gastro-oesophageal reflux.

Adolescent↗
PubMed1991

Rationalising the management of swallowed coins in children.

OBJECTIVE: To assess the management of swallowed coins in children and identify aspects that could be improved. DESIGN: Study of records of three hospital departments for 1986-90. SETTING: Accident and emergency, radiology, and operating theatre departments in a children's hospital. SUBJECTS: 50 children reported to have ingested coins. MAIN OUTCOME MEASURES: Radiological investigations performed, position of coin, symptoms of child, and surgical intervention. RESULTS: 50 children were recorded to have swallowed coins during 1986-90. Five children had only chest radiography, five only abdominal radiography, and 40 had both. A coin was detected in the oesophagus in 15 children, six of whom had symptoms, and below the cardia in 26, none of whom had symptoms; no coin was seen in nine children. Eleven children had further abdominal radiographs despite the absence of gastrointestinal symptoms; one child had a coin removed from the stomach. CONCLUSIONS: Children are being unnecessarily exposed to radiation and surgical intervention, and a consensus on management of swallowed coins is needed. Most children require only a single chest and neck radiograph.

Algorithms↗
PubMed2000

Swallow syncope associated with complete atrioventricular block and vasovagal syncope.

A 21 year old man presented with multiple, recurrent episodes of complete atrioventricular (AV) block associated with swallowing. Electrophysiological study revealed an AV block with swallowing of carbonated beverages and balloon inflation in the lower oesophagus. Evaluation did not demonstrate any underlying oesophageal or cardiac disease, and the AV block was not induced after intravenous atropine administration. The AV block was probably caused by a hypersensitive vagotonic reflex triggered by mechanical receptors in the lower oesophagus, resulting in suppression of the AV node. Head up tilt test revealed an increase in the high frequency spectrum of heart rate variability before the onset of the syncope. These findings suggest that the amplitude of the continual fluctuations in response to a variety of stimuli and derangement from both intrinsic and extrinsic environments was greater in this patient than in normal subjects. Swallow syncope is an unusual but treatable disorder. These reflexes that become exaggerated to the point of causing illness are poorly understood.

Adult↗
PubMed1998

Systemic activity of inhaled and swallowed beclomethasone dipropionate and the effect of different inhaler devices.

Inhaled glucocorticoids such as beclomethasone dipropionate, which are used in the treatment of asthma, may be associated with systemic adverse effects. To determine whether any systemic absorption following the inhalation of beclomethasone was a result of drug being absorbed from the lung (inhaled fraction) or the gastrointestinal tract (swallowed fraction), we studied normal subjects after the inhalation or swallowing of 2 mg beclomethasone dipropionate. Systemic activity was assessed using early morning cortisol suppression. Both inhaled and swallowed fractions produced significant systemic activity, the degree of which depended on the inhaler device used. Systemic activity was greater using a dry powder inhaler (52%) than using a metered dose inhaler with a large volume spacer (28%). These findings suggest that to limit potential adverse effects from high-dose beclomethasone dipropionate it is better to use a metered dose aerosol with large volume spacer than a dry powder.

Administration, Inhalation↗
PubMed1992

Pharmacological characterization of lower esophageal sphincter relaxation induced by swallowing, vagal efferent nerve stimulation, and esophageal distention.

To characterize the neural pathways involved in lower esophageal sphincter relaxation, intraluminal pressures from the lower esophageal sphincter of the opossum were monitored during swallowing, vagal efferent nerve stimulation, and intraluminal balloon distention in the presence and absence of pharmacologic antagonism of putative neurotransmitters. The combination of atropine, hexamethonium, and 5-methoxydimethyltryptamine, which is known to block ganglionic transmission in the vagal inhibitory pathway to the lower esophageal sphincter, significantly antagonized LES relaxation induced by both swallowing and vagal stimulation, but did not affect the LES relaxation induced by balloon distention. Administration of the nitric oxide synthase inhibitor N omega nitro-L-arginine methyl ester, on the other hand, markedly inhibited LES relaxation induced by vagal stimulation, swallowing, and balloon distention, and this effect was reversed by administration of the nitric oxide synthase substrate L-arginine. These studies indicate that the distension-induced intramural pathway mediating LES relaxation does not involve ganglionic transmission similar to that of the vagal inhibitory pathway to the LES. However, the LES relaxation induced by all forms of stimuli appears to depend on nitric oxide as a final mediator.

Animals↗
PubMed2002

Mechanisms of airway protection during retching, vomiting, and swallowing.

We investigated the mechanisms of airway protection and bolus transport during retching and vomiting by recording responses of the pharyngeal, laryngeal, and hyoid muscles and comparing them with responses during swallowing and responses of the gastrointestinal tract. Five dogs were chronically instrumented with electrodes on the striated muscles and strain gauges on smooth muscles. Retching and vomiting were stimulated by apomorphine (5-10 ug/kg iv). During retching, the hyoid and thyroid descending and laryngeal abductor muscles were activated; between retches, the hyoid, thyroid, and pharyngeal elevating, and laryngeal adductor muscles were activated. Vomiting always occurred during the ascending phase of retching and consisted of three sequential phases of hyoid and pharyngeal muscle activation culminating in simultaneous activation of all recorded elevating and descending laryngeal, hyoid, and pharyngeal muscles. Retrograde activation of esophagus and pharyngeal muscles occurred during the later phases, and laryngeal adductor was maximally activated in all phases of the vomit. During swallowing, the laryngeal adductor activation was followed immediately by brief activation of the laryngeal abductor. We concluded that retching functions to mix gastric contents with refluxed intestinal secretions and to impart an orad momentum to the bolus before vomiting. During retches, the airway is protected by glottal closure, and between retches, it is protected by ascent of the larynx and closure of the upper esophageal sphincter. The airway is protected by maximum glottal closure during vomiting. During swallowing, the airway is protected by laryngeal elevation and glottal closure followed by brief opening of the glottis, which may release subglottal pressure expelling material from the laryngeal vestibule.

Animals↗
PubMed2006

Effect of aging on bolus kinematics during the pharyngeal phase of swallowing.

Swallowing difficulty is a common complaint in the elderly and, although there are data for the biomechanics of liquid swallows, little is known about solid bolus motion, or kinematics, in the elderly. The aims of this study were as follows: 1) to characterize and compare solid and liquid bolus kinematics in the elderly and compare the findings with those in young subjects and 2) to correlate bolus kinematics and dynamics. Concurrent manometric-fluoroscopic techniques were used to study eight young and eight elderly subjects. The subjects performed four swallows each of 0.2-cm-diameter solid barium pellets and 5 ml of liquid barium during sagittal fluoroscopy and six-channel pharyngoesophageal manometry. Images were digitized for analysis of kinematic properties such as velocity and acceleration. Dynamic pressures were recorded and coordinated with kinematic events. Image analysis showed that velocity varied as the pellet passed through the hypopharynx, pharynx, and upper esophageal sphincter. In young subjects, pellet kinematics were characterized by two zones of pellet acceleration: one over the tongue base and another as the pellet passed through the upper esophageal sphincter. Although the elderly showed a similar zone of acceleration over the base of the tongue, the second zone of pellet acceleration was not seen. Decreasing pressure gradients immediately distal to the position of the solid pellet and liquid bolus characterized dynamics for all subjects. This decreasing pressure gradient was significantly larger in elderly than in young subjects. Bolus kinematics and dynamics were significantly altered among elderly compared with young subjects. Among these differences were the absence of hypopharyngeal bolus acceleration and a significant increase in the trans-sphincteric pressure gradient in the elderly.

Adolescent↗
PubMed1991

Shortening of the esophagus in response to swallowing.

Esophageal shortening accompanies peristalsis in laboratory animals and is attributed to longitudinally oriented fibers in esophageal muscle layers. To evaluate this phenomenon in humans, esophageal shortening during suspended respiration in response to swallows was measured in five normal volunteers (median age, 23 yr). Metal mucosal clips were endoscopically placed at and 10 cm above the gastroesophageal junction, and their movement was recorded by videotaped fluoroscopy. All subjects demonstrated esophageal shortening with each swallow in a characteristic pattern with small interswallow variance. Early, minimal shortening of the proximal segment (6.0 +/- 2.4 mm) was followed by delayed, prominent distal segment shortening (18.9 +/- 9.3 mm) that principally accounted for overall change in total esophageal length (18.0 +/- 8.1 mm). The degree of esophageal shortening did not correlate with circular muscle contraction wave parameters that were obtained with intraluminal manometrics in a separate study (P greater than 0.2 for each correlation), and distal segment shortening uniformly preceded the onset of contraction waves in the same region. These findings indicate that patterned esophageal shortening with swallows occurs in humans, most prominently in the distal esophagus. The technique may be useful in determining the participation of axial esophageal movement in esophageal motility disorders.

Adult↗
PubMed1995

Influence of gravity and body position on normal oropharyngeal swallowing.

The influence of gravity, if any, on pharyngeal bolus transport is unknown. The aim of the present study was to evaluate the effect of gravity and body position on the radiological and manometric events during the normal oropharyngeal swallow. In eight healthy male volunteers, we performed simultaneous videoradiography and manometry, using a manometry catheter incorporating a perfused sleeve measuring upper esophageal sphincter pressure and three solid-state transducers recording pharyngeal pressures. Swallows of 5 and 10 ml of barium were performed in three different body positions: upright, horizontal, and 30 degrees head down (inverted). Hypopharyngeal intrabolus pressure increased significantly in the horizontal and inverted positions compared with upright, P = 0.0001. This resulted in increased maximal sphincter diameters during bolus flow (P = 0.0001) and shorter duration of sphincter opening (P = 0.03). As a result, transsphincteric flow increased in the horizontal and inverted positions, P = 0.04. Total swallowing duration, oral and pharyngeal transit time, pharyngeal peristaltic amplitude and duration, the length of the bolus in the pharynx, and excursions of the hyoid and larynx were unaffected by body position. We conclude that intrabolus pressure is an important determinant of upper esophageal sphincter opening in the healthy oropharynx and that gravity does not influence pharyngeal bolus transport. The healthy upper esophageal sphincter has residual opening capacity that can be demonstrated by altering body posture.

Adult↗
PubMed1999

Cortical activation during human volitional swallowing: an event-related fMRI study.

Functional magnetic resonance imaging (fMRI) provides a safe, noninvasive method for studying task-related cortical neuronal activity. Because the cerebral cortex is strongly implicated in the control of human swallowing, we sought to identify its functional neuroanatomy using fMRI. In 10 healthy volunteers, a swallow event-related paradigm was performed by injecting 5 ml water bolus into the oral cavity every 30 s. Whole brain functional magnetic susceptibility -weighted spiral imaging data were simultaneously acquired over 600 s on a 1.5-T magnetic resonance scanner, utilizing the blood oxygenation level-dependent technique, and correlation maps were generated using both >99% percentile rank and spatial extent thresholding. We observed areas of increased signal change consistently in caudal sensorimotor cortex, anterior insula, premotor cortex, frontal operculum, anterior cingulate and prefrontal cortex, anterolateral and posterior parietal cortex, and precuneus and superiomedial temporal cortex. Less consistent activations were also seen in posterior cingulate cortex and putamen and caudate nuclei. Activations were bilateral, but almost every region, particularly the premotor, insular, and frontal opercular cortices, displayed lateralization to one or the other hemisphere. Swallow-related cortical activity is multidimensional, recruiting brain areas implicated in processing motor, sensory, and attention/affective aspects of the task.

Adult↗