Shaker R, Dodds W J, Ren J, Hogan W J, Arndorfer R C
Department of Medicine, Medical College of Wisconsin, Milwaukee.
Gastroenterology. 1992 Mar;102(3):857-61. doi: 10.1016/0016-5085(92)90169-y.
Abrupt esophageal distention occurs commonly during gastroesophageal reflux, thereby generating a circumstance favorable to esophagopharyngeal regurgitation and laryngeal aspiration of gastric refluxate. The aims of the present study were to examine the glottal response to esophageal distention by air and regional esophageal distention by a balloon. Fifteen healthy volunteers (age, 25 +/- 5 years) were studied while they were in an upright position. Using concurrent videoendoscopy and manometry, glottal and upper esophageal sphincter (UES) responses to abrupt esophageal distention by air injection (10-60 mL) and balloon distention (1.5, 2.0, and 2.5 cm) were recorded simultaneously. In addition, 6 subjects were studied with concurrent synchronized videofluoroscopy. Results showed that esophageal distention by air at a threshold volume of 10-60 mL caused vocal cord closure. The UES response to this threshold volume was variable. Volumes larger than the threshold value caused complete UES relaxation and belching. In addition to vocal cord closure, belching was accompanied by anterior movement of the glottis. On videofluoroscopy, the hyoid bone moved anteriorly in association with belching, but not with vocal cord closure without belching. Proximal esophageal distention by the balloon also provoked vocal cord closure. This response was less consistent for balloon distention in the middle and distal esophagus. It is concluded that (a) esophageal distention by either air or a balloon evokes a glottal closure mechanism, thereby suggesting the existence of an esophagoglottal reflex; (b) this reflex is elicited most easily by distention of the proximal esophagus; (c) glottal and UES responses to esophageal distention are independent from each other; and (d) the esophagoglottal closure reflex may play an important role in preventing laryngeal aspiration of acid due to gastroesophageal reflux accompanied by acid regurgitation into the pharynx.
胃食管反流期间常发生食管突然扩张，从而产生有利于胃反流物食管咽反流和喉吸入的情况。本研究的目的是通过空气扩张食管和用球囊进行局部食管扩张来检查声门对食管扩张的反应。对15名健康志愿者（年龄25±5岁）在直立位时进行了研究。使用同步视频内镜检查和测压法，同时记录声门和食管上括约肌（UES）对通过注入空气（10 - 60 mL）和球囊扩张（1.5、2.0和2.5 cm）引起的食管突然扩张的反应。此外，对6名受试者进行了同步视频荧光透视检查。结果显示，在10 - 60 mL的阈值容积下通过空气扩张食管会导致声带闭合。UES对该阈值容积的反应是可变的。大于阈值的容积会导致UES完全松弛和嗳气。除了声带闭合外，嗳气还伴有声门向前移动。在视频荧光透视检查中，舌骨会随着嗳气向前移动，但在无声带闭合的情况下则不会。球囊对食管近端的扩张也会引发声带闭合。对于食管中、远端的球囊扩张，这种反应不太一致。得出的结论是：（a）空气或球囊引起的食管扩张会引发声门闭合机制，从而提示存在食管声门反射；（b）这种反射最容易由食管近端的扩张引发；（c）声门和UES对食管扩张的反应相互独立；（d）食管声门闭合反射可能在预防因胃食管反流伴酸反流至咽部而导致的酸性物质喉吸入方面发挥重要作用。
