title: Neuromotor mechanisms of pharyngoesophageal motility in dysphagic infants with congenital heart disease.
abstract: BACKGROUND
  Aero-digestive morbidities are common in congenital heart disease infants, and the mechanisms are unclear. We hypothesized that adaptive pharyngoesophageal motility reflexes are different in surgical congenital heart disease infants (S-CHD) vs. nonsurgical congenital heart disease infants (CHD) and healthy controls.
  
  
  METHODS
  Abrupt pharyngeal provocation was performed with graded water infusions using purpose-built micromanometry. The data from 12 S-CHD were compared with data from 10 CHD and 12 controls. One hundred and ninety-seven water stimulations were examined for the frequency, latency, duration, and magnitude of pharyngo-upper esophageal sphincter contractile response (PUCR), pharyngeal reflexive swallow (PRS), esophageal body peristalsis, and lower esophageal sphincter (LES) relaxation characteristics. Mixed statistical models were applied.
  
  
  RESULTS
  Frequency distribution (%) of PUCR: PRS: none in S-CHD vs. CHD vs. controls, respectively, were 36:46:17 vs. 9:80:11 vs. 15:61:24 (P < 0.05). Response latency to the final esophageal body waveform (P = 0.01) and the response duration of esophageal body peristalsis (P = 0.04) were prolonged in S-CHD vs. controls but were similar to CHD (P = 0.22). Pharyngeal infusion-induced LES relaxation characteristics were similar in all three groups.
  
  
  CONCLUSIONS
  Abnormality in the recruitment of PUCR or PRS reflexes and esophageal body peristalsis in S-CHD implicate dysregulation in vagal cholinergic excitatory neuromotor responses.
authors.affiliation: 1] Section of Neonatology, The Neonatal and Infant Feeding Disorders Program, Nationwide Children's Hospital, Columbus, Ohio [2] Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: Manish B
authors.initials: MB
authors.lastname: Malkar
authors.affiliation: 1] Section of Neonatology, The Neonatal and Infant Feeding Disorders Program, Nationwide Children's Hospital, Columbus, Ohio [2] Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio [3] Section of Pediatric Gastroenterology and Nutrition, Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Sudarshan
authors.initials: S
authors.lastname: Jadcherla
mesh_terms: D000704:Analysis of Variance; D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D005769:Gastrointestinal Motility / Q000502:physiology*; D006330:Heart Defects, Congenital / Q000150:complications* / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008365:Manometry / Q000379:methods; D009119:Muscle Contraction / Q000502:physiology; D010528:Peristalsis / Q000502:physiology; D014867:Water / Q000008:administration & dosage
chemical_list: D014867:Water