COMMENTARY
See article on page 537
Swallowing is a precarious business
| The first 150 words of the full text of this article appear below. |
The upper oesophageal sphincter (UOS) remains closed
at rest as a result of a combination of intrinsic muscle tone and
passive pressure from the anterior mass of the larynx. This tonic
activity is augmented during inspiration, thus preventing oesophageal
air penetration each time intrathoracic pressure falls. UOS tonic pressure undergoes a further augmentation if the tubular oesophagus is
distended
a protective reflex against oesophagopharyngeal
regurgitation. Once oral preparation of an ingested bolus is complete,
UOS tonic activity is abolished during the pharyngeal phase of a
swallow. As the laryngopharynx elevates and shortens to engulf the
bolus, the simultaneous forward tug of the rising hyoid on the anterior UOS wall brings about mechanical opening of the sphincter.
The nature of the deglutition reflex remains somewhat mysterious. The
trigger to the onset of the ultra-rapid pharyngeal phase of swallowing
is only semireflexive. All of us at times select the preferred moment
of
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Gut 1998 43: 537-541.[Abstract] [Full Text] [PDF]
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