L9- Physiology of esophagus and deglutition

1. Discuss functional structure of esophygus

2. Describe the anti-reflux function and its regulation
3. Discuss phases of deglutition and correlate to the importance
4. Describe the control mechanism of diglutition
5. Differentiate between types of peristalsis in esophygus
6. Correlate between esophageal peristalsis and their functions

In the buccal cavity, mastication and salivary secretion take place resulting in formation of a
suitable bolus. This is followed by deglutition (= swallowing) which involves propulsion of the
bolus into the pharynx then downward through the esophagus to the stomach.

MASTICATION (CHEWING)
Mastication is the process of breakdown of large food particles into small pieces. It involves the
actions of the teeth and molars as well as the movements of the lips, tongue and mandible.
Mandibular movements are performed by the muscles of mastication (= the masseter, temporalis
and medial and lateral pterygoid muscles) which are supplied by the mandibular branch of the
trigeminal nerve (= 5th cranial nerve). Such movements can occur voluntarily but the rhythmic
opening and closing of the mouth during mastication is probably a programmed pattern of
movements organized in the CNS. It involves the nucleus of the fifth cranial nerve (pons).

Functions of mastication
(1) It helps swallowing by mixing the food with saliva, forming an easily swallowed bolus.
(2) It helps digestion by increasing the surface area of f'ood exposed to the digestive enzymes
(3) It reduces the mechanical damage to the GIT mucosa.
(4) It leads to stimulation of the taste and smell receptors important for sensing the flavour of
food.

Physiology of esophagus
The esophagus is a muscular tube about 25cm long. The top-third contains skeletal muscle and
moves rapidly. The lower two-thirds contain smooth muscle arranged as inner circular and outer
longitudinal layers and its movement is slow.
All esophageal muscles are controlled by the vagus. The skeletal muscle is innervated directly by
somatic motor neurones from the nucleus ambigus, whilst the smooth muscle is innervated
indirectly by neurones from the dorsal motor nucleus that synapse with neurones in the
myenteric plexus.

The upper oesophageal sphincter (pharyngeo-esophygeal sphincter) is composed of skeletal

muscle. It remains closed at rest. It opens during swallowing. Immediately after the bolus has
passed, it closes again. Its resting tension is normally high. This prevents aero- phagia.

The lower sphincter (the gastroesophageal or cardiac sphincter LES) comprises the last 1–3 cm
of the oesophagus. It is not anatomically distinguishable as a discrete sphincter. It is innervated
by both extrinsic and intrinsic nerves.
Function of the esophagus
1. The transfer function, the food bolus is transferred from the pharynx above to the
stomach.
2. The anti-reflux function, regurgitation of food and liquids is prevented from below
upwards. The anti-reflux function is mainly mediated by the lower esophageal sphincter.
Between meals, the vagal cholinergic impulses are partly responsible for the maintained
tonic contraction in LES to prevent the reflux. Stimulation of noradrenergic sympathetic
nerves also causes contraction via activation of α-adrenergic receptors. However, if the
extrinsic nerves are cut there is still some tone indicating that the intrinsic nerves are also
important. Large doses of gastrin hormone increases the tone of the lower esophageal
sphincter.
It relaxes when peristaltic waves reaches it during swallowing, by inhibitory nerves to the
circular muscle layer. The transmitters involved may be the vasoactive intestinal
polypeptide (VIP) and nitric oxide. A decrease in cholinergic impulses also promotes
relaxation of LES.

3. A third complementary function is secretion of mucoid material to facilitate swallowing.

Mucus in the upper part of the esophagus prevents excoriation of the mucosa by food,
and in the lower part protects the esophageal wall from digestion by gastric reflux into
the esophagus.

Swallowing (deglutition):

It is the transfer of food from the mouth to the stomach. The whole process lasts only a few
seconds. It is initiated voluntarily but continue as a classical reflex. The deglutition center is
situated in the medulla oblongata.
It involves efferent impulses from the medulla to 25 different skeletal muscles of the pharynx,
the larynx, and the early oesophagus and the smooth muscles in the lower oesophagus.
Speed of swallowing depends on the consistency of food. Fluids reach the stomach in about 6
seconds, faster than the esophageal peristalsis due to effect of gravity in erect posture, but they
remain above the cardiac sphincter until a peristaltic wave opens this sphincter.
Semisolids take a longer time than fluids and solid materials are slower than semisolids.

Phases of swallowing

The process can be divided into three phases: voluntary, pharyngeal, and oesophageal, without
an interval in between:

I- Oral (buccal) phase

In the voluntary phase, the tongue moves backwards and upwards against the hard palate by
contraction of the mylohyoid muscles, so the bolus is propelled backwards into the pharynx.
 II- Pharyngeal phase

It is an involuntary very rapid reflex; the swallowing reflex, that cannot be prevented once it
starts. It takes about 1-2 seconds.

During this phase, the constrictor muscles of the pharynx contract, with receptive relaxation of
the upper esophageal sphincter.

It starts by pushing the food bolus to the back of the mouth by the tongue to enter the pharynx.
The bolus activates pressure receptors in the palate and anterior pharynx. Afferents impulses in
the trigeminal and glossopharyngeal nerves stimulate the swallowing centre. Each impulse serves
as a trigger for the swallowing reflex. It results in:

- Approximation of the posterior pillars of the fauces to shut off the mouth cavity from the
pharynx and prevent the back passage of food to it.
- Elevation of the soft palate that seals the nasal cavity and prevents food from entering it.
- The swallowing centre inhibits respiration (reflex apnea), raises the larynx, and closes the
glottis (the opening between the vocal chords). This prevents food from getting into the
trachea. As the tongue forces the food further back into the pharynx, the bolus tilts the
epiglottis backwards to cover the closed glottis.

III- Oesophageal phase

This is also an involuntary stage in which a peristaltic movement is initiated in the upper part of
the esophagus then it extends downwards along its wall, resulting in propulsion of the bolus into
the stomach.

A peristaltic wave consists of a wave of contraction of the circular muscle, followed by a wave
of relaxation. The wave of contraction passes along the walls towards the stomach. The
esophageal peristalsis travels at a rate 3-4 cm /second (travelling the esophagus in about 8- 10
seconds). However, in the upright position, food moves faster by the effect of gravity, so it can
be transmitted to the lower end of the esophagus in only 5-8 seconds.

As the peristaltic waves begin in the oesophagus, the muscle of the lower oesophageal sphincter
relaxes, but there is a delay of 2-3 seconds at this area before food enters the stomach.The
sphincter muscle then contracts and reseals the junction. So, this area is particularly vulnerable to
damage and ulceration by hot, cold or irritant food.

There are 2 types of esophageal peristalsis:

(1) Primary peristalsis : This is a continuation of the peristaltic wave that begins in the pharynx.
They even start before food reaches the esophagus.

(2) Secondary peristalsis: This occurs if the primary peristalsis fails to propel all food entered the
esophagus. It originates in the esophagus itself as a result of distention. This type of peristalsis
does not necessarily involve the whole esophagus. it spares the part proximal to the site of
distension. They are initiated partly by the local myenteric reflexes and partly by the swallowing
reflex.

The progression of the wave is controlled by autonomic vagal nerves that utilize acetylcholine
and is coordinated by the swallowing centre.

The primary type is produced by efferent vagal nerve fibres while the secondary type is produced
through a vago-vagal reflex. Secondary peristalsis in the lower part of the esophagus can also be
initiated by local enteric reflexes.

Nervous pathways in deglutition

The reflexes of the involuntary phases are mediated by:
1. Afferents: start from receptors that discharge impulses from the upper pharynx along the
5th, 9th, 10th cranial nerves.
2. Center: is the deglutition centre in the medulla oblongata.
3. Efferents: are along the 5th cranial nerve to mylohyoid muscles, the 9th,10th and 11th
cranial nerves to the pharyngeal and esophageal muscles and the 12thcranial nerve to the
tongue muscles.