Dantas Roberto Oliveira
Department of Medicine, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto SP, Brazil.
Int Arch Otorhinolaryngol. 2021 Jul 28;26(4):e519-e523. doi: 10.1055/s-0040-1722160. eCollection 2022 Oct.
The upper esophageal sphincter (UES) is a muscular structure located at the transition from the pharynx to the esophagus, with the cricopharyngeal muscle as the most important component. During gastroesophageal reflux, the pressure in the UES elevates, which is apparently a protective mechanism to prevent esophagopharyngeal reflux and airway aspiration. In gastroesophageal reflux disease (GERD), there may be functional changes in the UES. The objective of the present review was to determine UES functional changes in GERD. In healthy individuals, gastroesophageal reflux causes an increase in the UES pressure. This response of the sphincter is at least partially impaired in patients with GERD. In the disease, the UES has a reduced length and decreased resting pressure. However, other publications found that in chronic gastroesophageal reflux the basal sphincter pressure increase, differences which may be consequent to the measurement method or to disease severity. The UES opening during swallowing has a smaller diameter, and the bolus transit time through the sphincter is longer. The UES of patients with GERD does not open as expected and the bolus flow through the sphincter is longer. This behavior may be associated with dysphagia, a frequent complaint in patients with GERD.
上食管括约肌（UES）是位于从咽部到食管过渡处的肌肉结构，其中环咽肌是最重要的组成部分。在胃食管反流期间，UES压力升高，这显然是一种防止食管咽部反流和气道误吸的保护机制。在胃食管反流病（GERD）中，UES可能存在功能变化。 本综述的目的是确定GERD中UES的功能变化。 在健康个体中，胃食管反流会导致UES压力升高。在GERD患者中，这种括约肌反应至少部分受损。在该疾病中，UES长度缩短且静息压力降低。然而，其他研究发现，在慢性胃食管反流中，基础括约肌压力升高，这些差异可能是由于测量方法或疾病严重程度所致。吞咽时UES开口直径较小，食团通过括约肌的运输时间较长。 GERD患者的UES不能如预期那样开放，食团通过括约肌的流动时间更长。这种行为可能与吞咽困难有关，吞咽困难是GERD患者常见的主诉。
