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GI motility

Swallowing
2nd stage of food ingestion
1. Voluntary stage- initiation
tongue move up and back against palate
bolus voluntarily squeezed into pharynx
2. Pharyngeal stage
Bolus enters posterior mouth stimulating epithelial swallowing receptor areas (initiating
deglutition/swallowing reflex)
Impulses initiate automatic pharyngeal muscle contractions
Soft palate closes nasopharynx area
Palatopharyngeal folds pulled medially to allow sagittal slit to form
Vocal cords tightly closed, larynx is pulled upward and anteriorly
Epiglottis swings back over the larynx
Upward movement of larynx enlarges esophageal opening, upper esophageal sphincter (UES)
relaxes
Raised larynx and relaxation of UES results in contraction of the muscular wall of pharynx
3. Esophageal stage
Primary Peristalsis Secondary Peristalsis
Continuation of pharyngeal peristalsis Stimulated if bolus remains in esophagus after
primary peristalsis

Residual food in the esophagus, may be cleared by

what is called secondary peristalsis.
Distention of the esophagus causes activation of
local sensory nerves that elicits contraction above
the distention and relaxation below it.

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Esophagus cross-section

Esophagus
Muscularis externa helps ID location of esophagus
Likely upper-mid section of esophagus
o Circular muscle in muscularis externa contains both striated and smooth muscle
Innervation
o Musculature of pharyngeal wall and upper 1/3 esophagus is striated muscle (skeletal nerve
impulses from glossopharngeal and vagus nerve
o Lower 2/3 musculature is smooth muscle (also vagus nerves working through myentric nervous
system)

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peristalsis

Dysphagia
Sensation of sticking or obstruction of passage of food through the
mouth, pharynx, esophagus
Oral dysphagia- poor bolus formation/control
Pharyngeal dysphagia- Stasis of food in pharynx due to poor pharyngeal propulsion and obstruction
at UES
Oropharyngeal Dysphagia
Nasal regurgitation and laryngeal aspiration are classic symptoms of oropharyngeal dysphagia
Mechanical Motor
Head and neck tumors Impairment of voluntary effort
Radiation therapy - strictures Diseases of cerebral cortex
Inflammatory processes With or without altered
consciousness or dementia
Disease of cranial nerves (V, VII, IX,
X, XII)
Muscle disorders (myositis,
metabolic myopathy)

Esophageal dysphagia
o Adult esophageal lumen ~ 4 cm diameter
Solid food dysphagia occurs ~ 2.5 cm
General dysphagia occurs < 1.4 cm
Circumferential lesions common
Mechanical: carcinoma, benign strictures
Motor: abnormalities in peristalsis and deglutitive inhibition due to disease of striated or
smooth muscle
Diffuse esophageal Spasm (DES) inhibitory innervation only to esophageal body impaired
Achalasia inhibitory innervation to both the esophageal body and LES impaired
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Gastroesophageal Reflux Disease (GERD) esophageal muscle weakness

Mechanical dysphagia- large bolus, narrow lumen

Motor dysphagia- impaired deglutition reflex, impaired sphincter relax, weak peristaltic contractions

Achalasia
Special form of dysphagia
Definition: Failure to relax
o LES does not open fully (food is retained at level of LES)
o Chronic disorder of the innervation of LES
o Histology: degeneration of nerve ganglion cells within
myenteric plexus of enteric nervous system (immune attack)

Treatment
o Difficult
o Balloons
o Injection of botulinum toxin
into the sphincter region
This toxin irreversibly
inhibits the release of
ACh from presynaptic
terminals, removing major stimulus to sphincter