DEGLUTITION REFLEX

DR AMNA TAHIR
ASSISTANT PROFESSOR
PHYSIOLOGY DEPARTMENT
 Stages of Swallowing
(Deglutition)

Oral stage (voluntary)

Pharyngeal stage

Esophageal stage
 Swallowing (Deglutition)

Vagus & glossopharyngeal nerves for

upper 1/3
Vagus nerve innervates the lower 2/3
Swallowing (Deglutition)
Brain Stem (medulla & pons)
(swallowing center)

CN V, IX, X & XII

 Swallowing (Deglution)

Swallowing can be divided into:

Voluntary stage of swallowing
Bolus voluntarily squeezed or rolled
posteriorly against the palate
Swallowing cannot be stopped
Pharyngeal stage of swallowing
Bolus reaches posterior mouth & pharynx
stimulates receptors initiate series of
automatic pharyngeal muscle contraction
 Automatic pharyngeal muscle
contraction:
Soft palate is pulled upward and prevents the reflux of
food to nasal cavity
Palatopharyngeal folds are pulled medially to
approximate each other form a saggital slit
Vocal cords are approximated
Larynx is pulled upward & anterior by neck muscles
Epiglottis swing backward over the opening of larynx
 Automatic pharyngeal muscle
contraction:

Upward movement of larynx &

enlargement the opening of esophagus
Upper 3-4cm of esophagus relaxes
Muscular wall of pharynx contracts to push
the food downward (propulsive
contraction)

N.B. pharyngeal stage lasts for < 2 sec

 Swallowing (Deglution)

Esophageal stage of swallowing

Conducts food rapidly to the stomach
Two types of peristaltic movements:
1 peristalsis:
continuation of a peristaltic wave
begins in pharynx & spreads into esophagus
passes in 8-10 sec
2 peristaltic waves:
results from the distention of esophagus
begins if the 1 wave failed to push the food down
Deglutition (Swallowing)

Figure 22.13a-c
 Receptive relaxation of
stomach

As the waves of peristalsis pass thru

esophagus to stomach, a wave of
relaxation precedes the peristalsis,
which transmitted thru myenteric
inhibitory neurons
 Function of lower esophageal sphincter
(Gastroesophageal sphincter)
above the junction of esophagus with
stomach by 3cm
remains tonically constricted
peristaltic swallowing wave passes down
esophagus receptive relaxation of
gastro-esophageal sphincter allow food
go easily to stomach
Sphincter does not relax satisfactorily
condition called achalasia
Lower Esophageal Sphincter
Esophageal reflux can be prevented
by:
Gastro-esophageal sphincter
Valve-like mechanism: short portion
of the esophagus that extends
beneath the diaphragm before
opening into stomach
Deglutition (Swallowing)

Figure 22.13d, e
 the factors that contribute to
the competence and tone of
the lower esophageal
sphincter
Lower esophageal sphincter (LOS) is formed by
the lowest 2 4cm segment of the esophagus
- Physiological sphincter
Resting pressure: 15 25mmHg (20 30 cmH2O)
above gastric pressure Prevents reflux
 - Barrier pressure = LOS P
intragastric P (10cmH2O @ rest)
Normally Barrier P = 25cmH2O,
reflux at <13cmH2O intra-
abdominal P (pregnancy) will
intragastric P barrier P
 Neural Control
Internal relaxation-
contraction cycling (smooth mm)
coordinated by medulla via vagus
External portion of sphincter (crura)
supplied by phrenic nerve
 Factors contributing to
competence/tone

1-Tonic contraction of circular muscle

fibers
2-Oblique gastro-esphageal angle
forms a mucosal flap-valve mechanism
3-Crura of diaphragm
forms pinch-cock mechanism
4- LOS is intra-abdominal
- Enhances LOS tone with positive IAP
rather than negative ITP

-LOS tone with cough/sneeze

5. Hormones
- LOS tone: gastrin, motilin, -adrenergic
stimulation, oestrogen
- LOS tone: secretin, glucagon, VIP,
GIP,PROGESTONE
Gastro esophageal reflux
Gastro esophageal reflux is a condition where
the acidic content of the stomach
regurgitates back into the esophagus. The
distal esophageal mucosa is non glandular in
type (it is squamous epithelium), therefore, it
can easily be damaged by chronic acid reflux.
-- TO prevent this, there are several
mechanisms in place
 The lower oesophageal sphincter (LOS) is
tonically active but relaxes on swallowing. The
tonic activity of the LOS between meals prevents
reflux of gastric contents into the oesophagus.
The prominent smooth muscle of the lower
oesophagus acts as a internal phincter to prevent
reflux.
The right crus of the diaphragm which surrounds
the oesophagus exerts a pinch-cock like action on
the oesophagus to prevent reflux (external
sphincter).
 The oblique or sling fibers of the stomach wall
create a flap valve that helps close off the
esophago-gastric junction and prevent
regurgitation when intra-gastric pressure rises.
Another factor that helps to prevent reflux is a
valve like mechanism of a short portion of the
esophagus that extends slightly into the stomach.
Increased intra-abdominal pressure caves the
esophagus inward at this point. Thus, this valve
like closure of the lower esophagus helps to
prevent high intra-abdominal pressure from forcing
stomach contents backward into the esophagus
 CAUSES OF DYSPHAGIA
Oral( painful mastication)
Oral malignancy
Tonsillitis
Herpes simplex
Aphthous ulceration
stomatitis
Pharyngeal
Following cerebrovascular disease
( stroke)
Bulbar and pseudo bulbar palsy
Pharyngeal malignancy
Myasthenia gravis
Motor neuron disease
Pharyngeal diverticulum
esophagus
Motility disorders
Achalasia
Diffuse spasm
Scleroderma
Extrinsic pressure
Mediastinal mass lesion
Bronchogenic carcinoma
Dilated left atrium
Aortic aneurysm
Foreign bodies
goitre
Intrinsic pressure
Benign esophageal stricture
Carcinoma
webs and rings
Lower esophageal ring
ACHALASIA CARDIA
 ACHALASIA CARDIA
It is a disease of an unknown etiology
characterized by aperistalsis in the
body of oesophagus and failure of
relaxation of lower oesophageal
sphincter on initiation of swallowng .
The food collects in capacious
oesophagus resulting in dilatation of
oesophagus
Pathophysiology
 Clinical features
Dysphagia
Regurgitation
Retrosternal chest pain
 Investigation
X-ray chest
Barium swallow
Oesophagoscoy
 Treatment
Endoscopic
Pneumatic dilatation
Botulism
Surgical