Shaker R, Kern M, Bardan E, Taylor A, Stewart E T, Hoffmann R G, Arndorfer R C, Hofmann C, Bonnevier J
Medical College of Wisconsin Dysphagia Institute, Department of Medicine, Milwaukee, USA.
Am J Physiol. 1997 Jun;272(6 Pt 1):G1518-22. doi: 10.1152/ajpgi.1997.272.6.G1518.
Earlier studies have shown that the cross-sectional area of the deglutitive upper esophageal sphincter (UES) opening in healthy asymptomatic elderly individuals is reduced compared with healthy young volunteers. The aim of this study was to determine the effect of a head-raising exercise on swallow-induced UES opening and hypopharyngeal intrabolus pressure in the elderly. We studied a total of 31 asymptomatic healthy elderly subjects by videofluoroscopy and manometry before and after real (19 subjects) and sham (12 subjects) exercises. A significant increase was found in the magnitude of the anterior excursion of the larynx, the maximum anteroposterior diameter, and the cross-sectional area of the UES opening after the real exercise (P < 0.05). These changes were associated with a significant decrease in the hypopharyngeal intrabolus pressure studied in 12 (real-exercise) and 6 (sham-exercise) subjects (P < 0.05). A similar effect was not found in the sham-exercise group. In normal elderly subjects, deglutitive UES opening is amenable to augmentation by exercise aimed at strengthening the UES opening muscles. This augmentation is accompanied by a significant decrease in hypopharyngeal intrabolus pressure, indicating a decrease in pharyngeal outflow resistance. This approach may be helpful in some patients with dysphagia due to disorders of deglutitive UES opening.
早期研究表明，与健康年轻志愿者相比，健康无症状老年人吞咽时上食管括约肌（UES）开口的横截面积减小。本研究的目的是确定抬头运动对老年人吞咽诱发的UES开口及下咽食团内压的影响。我们通过电视荧光吞咽造影和测压法，对31名无症状健康老年人在进行实际运动（19名受试者）和假运动（12名受试者）前后进行了研究。实际运动后，发现喉部向前移动的幅度、最大前后径以及UES开口的横截面积均显著增加（P < 0.05）。这些变化与在12名（实际运动组）和6名（假运动组）受试者中研究的下咽食团内压显著降低相关（P < 0.05）。假运动组未发现类似效果。在正常老年人中，吞咽时的UES开口可通过旨在增强UES开口肌肉的运动而增大。这种增大伴随着下咽食团内压的显著降低，表明咽流出阻力降低。这种方法可能对一些因吞咽时UES开口障碍导致吞咽困难的患者有帮助。
