Neurophysiology of Laryngopharyngeal Reflux and Brainstem Reflex

인후두역류증후군과 뇌간반사에 관한 신경생리

  • Han, Baek Hwa (Department of Otorhinolaryngolohy-Head and Neck Surgery, Chonbuk National University College of Medicine) ;
  • Hong, Ki Hwan (Department of Otorhinolaryngolohy-Head and Neck Surgery, Chonbuk National University College of Medicine)
  • 한백화 (전북대학교 의학전문대학원 이비인후과학교실) ;
  • 홍기환 (전북대학교 의학전문대학원 이비인후과학교실)
  • Received : 2016.05.11
  • Accepted : 2016.05.19
  • Published : 2016.12.30

Abstract

Laryngopharyngeal reflux disease (LPRD) is different with gastroesophageal reflux disease (GERD). The lower esophageal sphincter (LES) possesses an intrinsic nervous plexus that allows the LES to have a considerable degree of independent neural control. Sympathetic control of the LES and stomach stems from cholinergic preganglionic neurons in the intermediolateral column of the thoracic spinal cord (T6 through T9 divisions), which impinge on postganglionic neurons in the celiac ganglion, of which the catecholaminergic neurons provide the LES and stomach with most of its sympathetic supply. Sympathetic regulation of motility primarily involves inhibitory presynaptic modulation of vagal cholinergic input to postganglionic neurons in the enteric plexus. The magnitude of sympathetic inhibition of motility is directly proportional to the level of background vagal efferent input. Recognizing that the LES is under the dual control of the sympathetic and parasympathetic nervous systems, we refer the reader to other comprehensive reviews on the role of the sympathetic and parasympatetic control of LES and gastric function. The present review focuses on the functionally dominant parasympathetic control of the LES and stomach via the dorsal motor nucleus of the vagus.

Keywords

References

  1. Field SK, Underwood M, Brant R. Prevalence of gastroe-sophageal reflux symptoms in asthma. Chest 1996;109:316-22. https://doi.org/10.1378/chest.109.2.316
  2. Koufman JA. The otolaryngologic manifestations of gastroe-sophageal reflux disease. A clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope 1991;101:1-65.
  3. Richter JE. Atypical manifestations of gastroesophageal reflux disease: pulmonary and ear, nose, and throat. Gastrointestinal Dis Today 1996;5(6):1-7.
  4. Rogers RC, McTigue DM, Hermann GE. Vagovagal reflex control of digestion: afferent modulation by neural and "endoneurocrine" factors. Am J Physiol 1995; 268:G1-10.
  5. Browning KN. Excitability of nodose ganglion cells and their role in vago-vagal reflex control of gastrointestinal function. Curr Opin Pharmacol. 2003; 3:613-7. https://doi.org/10.1016/j.coph.2003.06.011
  6. Berthoud HR, Neuhuber WL. Functional and cehmical anatomy of the afferent vagal system. Auton Neurosci 2000;85:1-17. https://doi.org/10.1016/S1566-0702(00)00215-0
  7. Berthoud HR, Patterson LM, Zheng H. Vagal-enteric interface: vagal activation-induced expression of c-Fos and p-CREB in neurons of the upper gastrointestinal tract and pancreas. Anat Rec 2001;262:29-40. https://doi.org/10.1002/1097-0185(20010101)262:1<29::AID-AR1008>3.0.CO;2-B
  8. Berthoud HR, Blackshaw LA, Brookes SJ, Grundy D. Neuroanatomy of extrinsic afferents supplying the gastrointestinal tract. Neurogastroenterol Motil 2004;16 (Suppl 1):28-33. https://doi.org/10.1111/j.1743-3150.2004.00471.x
  9. Powley TL, Phillips RJ. Musings on the wanderer: what's new in our understanding of vago-vagal reflexes? I. Morphology and topography of vagal afferents innervating the GI tract. Am J Physiol Gastrointest Liver Physiol 2002;283:G1217-25. https://doi.org/10.1152/ajpgi.00249.2002
  10. Phillips RJ, Powley TL. Tension and stretch receptors in gastrointestinal smooth muscle: reevaluating vagal mechanoreceptor electrophysiology. Brain Res Rev. 2000; 34:1-26. https://doi.org/10.1016/S0165-0173(00)00036-9
  11. Koufman JA. Gastroesophageal reflux and voice disorders. In Rubin(eds). Diagnosis and treatment of voice disorders, lst ed. New York, Tokyo:Igaku-Shoin;1995. p.161-75.
  12. Belafsky PC, Postma GN, Koufiman JA. Validity and reliability of the feflux symptom indes (RSI). J Voice 2002;16:274-7. https://doi.org/10.1016/S0892-1997(02)00097-8
  13. Ylitalo R, Lindestad PA, Ramel S. Symptoms. Laryngeal findings, and 24-hour pH monitoring in patients with suspected gastroesophago pharyngeal reflux. Laryngoscope 2001;111:1735-41. https://doi.org/10.1097/00005537-200110000-00013
  14. Bilgen C, Ogut F, Kesimli-Dinc H, Kirazli T, Bor S. The comparison of an empiric proton pump inhibitor trial vs 24-hour doubleprobe Phmonitoring in laryngopharyngeal reflux. J Laryngol Otol 2003;117:386-90. https://doi.org/10.1258/002221503321626438
  15. Belafsky PC, Postma GN, Koufiman JA. The validity and reliability of the reflux finding score (RFS). Laryngoscope 2001;111:1313-7. https://doi.org/10.1097/00005537-200108000-00001
  16. Park KH, Choi SM, Kwon SU, Yoon SW, Kim SU. Diagnosis of laryngopharyngeal reflux among globus patients. Otolaryngol Head Neck Surg 2006;134:81-5. https://doi.org/10.1016/j.otohns.2005.08.025
  17. Kelchner LN, Horne J, Lee L, Klaben B, Stemple JC, Adam S, et al. Reliability of speech-language pathologist and otolaryngologist ratings of laryngeal signs of reflux in an asymptomatic population using the reflux finding score. J Voice 2007;21:92-100. https://doi.org/10.1016/j.jvoice.2005.09.004
  18. Branski RC, Bhattacharyya N, Shapiro J. The reliability of the assessment of endoscopic laryngeal findings associated with laryngopharyngeal feflux disease. Laryngoscope 2002;112:1019-24. https://doi.org/10.1097/00005537-200206000-00016