Lang Ivan M
Dysphagia Research Laboratory, Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
J Neurogastroenterol Motil. 2024 Oct 30;30(4):397-406. doi: 10.5056/jnm24003.
Although swallowing has been reviewed extensively, the coordination of the phases of swallowing have not. The phases are controlled by the brainstem, but peripheral factors help coordinate the phases. The occurrence, magnitude, and duration of esophageal phase depends upon peripheral feedback activated by the bolus. The esophageal phase does not occur without peripheral feedback from the esophagus. This feedback is mediated by esophageal slowly-adapting mucosal tension receptors through the recurrent and superior laryngeal nerves. A similar reflex mediated by the same peripheral pathway is the activation of swallowing by stimulation of the cervical esophagus. This reflex occurs primarily in human infants and animals, and this reflex may be important for protecting against aspiration after esophago-pharyngeal reflux. Not only are there inter-phase excitatory processes, but also inhibitory processes. A significant inhibitory process is deglutitive inhibition. When one swallows faster than peristalsis ends, peristalsis is inhibited by the new pharyngeal phase. This process prevents the ongoing esophageal peristaltic wave from blocking the bolus being pushed into the esophagus by the new wave. The esophageal phase returns during the last swallow of the sequence. This process is probably mediated by mucosal tension receptors through the superior laryngeal nerves. A similar reflex exists, the pharyngo-esophageal inhibitory reflex, but studies indicate that it is controlled by a different neural pathway. The pharyngo-esophageal inhibitory reflex is mediated by mucosal tension receptors through the glossopharyngeal nerve. In summary, there are significant peripheral processes that contribute to swallowing, whereby one phase of swallowing significantly affects the other.
尽管对吞咽已进行了广泛的综述，但吞咽各阶段的协调情况却未得到充分研究。这些阶段由脑干控制，但外周因素有助于协调各阶段。食管期的发生、强度和持续时间取决于食团激活的外周反馈。没有来自食管的外周反馈，食管期就不会发生。这种反馈是由食管缓慢适应的黏膜张力感受器通过喉返神经和喉上神经介导的。由相同外周途径介导的类似反射是刺激颈段食管引发吞咽。这种反射主要发生在人类婴儿和动物身上，可能对防止食管 - 咽反流后的误吸很重要。不仅存在阶段间的兴奋过程，也存在抑制过程。一个重要的抑制过程是吞咽抑制。当一个人吞咽速度快于蠕动结束时，新的咽期会抑制蠕动。这个过程可防止正在进行的食管蠕动波阻碍新一波将食团推入食管。食管期在一连串吞咽的最后一次吞咽时恢复。这个过程可能是由黏膜张力感受器通过喉上神经介导的。存在一种类似的反射，即咽 - 食管抑制反射，但研究表明它受不同的神经通路控制。咽 - 食管抑制反射是由黏膜张力感受器通过舌咽神经介导的。总之，存在显著的外周过程对吞咽有影响，其中一个吞咽阶段会显著影响另一个阶段。
