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The main physiological function of the esophagus is to carry food from the mouth to the stomach. This becomes possible due to the implementation of successively arising reflexes. Various departments of the nervous system participate in the complex reflex activity of the digestive tract: the cerebral cortex, the medulla oblongata, where according to K.M. Bykov is the center of swallowing, the nuclei of the vagus nerves, the spinal cord, the paravertebral nodes of the sympathetic nervous system, the intramural plexuses of the esophagus, cardia and stomach (Saks F.F. et al., 1987).
In the swallowing act, three phases are distinguished: oral, pharyngeal and esophageal. Swallowing solid and liquid food has known differences, which is of interest in the clinic of foreign bodies of the esophagus. In the first, oral, swallowing phase, the solid food mass is crushed and wetted with saliva. Through teeth, the primary control of the food lump is carried out. A bone or some other solid body that enters the mouth is detected and removed from the mouth. The crushed food in the oral cavity is subjected to further control due to the tongue pressing the food lump to the hard palate, the mucous membrane of which is innervated by the sensitive branches of the trigeminal nerve. The oral phase is an arbitrary act. Depending on the nature of the food, it can be fast or slow. Semi-liquid and especially liquid food advances quickly and the oral phase can be minimized and, therefore, control over the content of inclusions (bones, etc.) that are dangerous for the digestive tract can be significantly reduced. That is why, foreign bodies of the esophagus are most often found when taking liquid food (first course).
As soon as the food lump passes the anterior palatine arches, the second phase begins - the pharyngeal, which is an involuntary act and is carried out without the participation of volitional control over the progress of the food lump. The pharyngeal phase proceeds very quickly - less than 1 s. In the implementation of the second phase of swallowing, many muscles are involved, a certain and coordinated order of reduction of which ensures the closure of the communication of the oropharynx with the nasal cavity, mouth and larynx. At the same time, the entrance to the esophagus opens and a short stop in breathing occurs. Even small functional or morphological changes in any of the links of the neuromuscular apparatus of the esophagus, reflex pathways, or centers of its primary regulation, can cause various motor disorders (dysphagia, dyskinesia).
Numerous electromyographic and X-ray kinematographic research methods have made it possible to study this complex reflex act in detail. It is important to note the almost synchronous movements of the tongue and larynx that occur during the pharyngeal phase of swallowing. At the same time, the tongue moves back and the larynx up and forward. These two movements directed towards each other ensure that the entrance to the larynx is closed by the root of the tongue and epiglottis, even in the absence of the latter.
X-ray cinematic studies have confirmed the presence of advancement of muscle protrusion in the form of a roller that occurs in a limited area of the posterior wall of the upper pharynx at the level of the hard palate.
In the scientific literature, it is known as the Passavant roller and is part of the superior pharyngeal constrictor. Together with the muscles of the soft palate, the mentioned muscle protrusion provides isolation of the oral part of the pharynx from the nasopharynx. The second phase of swallowing ends with the delivery of the food lump from the pharynx to the esophagus.
The third phase of swallowing, the esophagus, begins with the passage of the food lump through the upper narrowing of the esophagus, which according to G. Desouches (1974) does not exceed 0.15 s. The movement of the food lump along the esophagus is accompanied by active motility. In this regard, the act of swallowing can be performed in any position of the body. Peristaltic contraction has the character of a wave that occurs in its upper part and propagates in the direction of the stomach. Distinguish between primary and secondary peristaltic waves. The primary peristaltic wave of the esophagus occurs reflexively in response to swallowing or when the cranial end of the esophagus contracts. According to published data, the primary peristaltic wave, depending on the nature and volume of the food lump, spreads through the esophagus in 2-12 seconds. A secondary peristaltic wave occurs in the esophagus in response to local irritation of the mucous membrane of the esophagus and is not directly related to the act of swallowing. Secondary peristaltic wave is an involuntary contraction of the smooth muscles of the esophagus, which usually begins at the level of the aortic narrowing of the esophagus and extends to its lower end. It is believed that it cleanses the esophagus from food debris by pushing them into the stomach.
Swallowing liquid food has its differences from swallowing solid food. When swallowing fluid, the oral phase, during which the food lump is controlled by the teeth and the hard palate, is practically absent. When the liquid is swallowed quickly by successive sips, the esophagus does not make peristaltic movements, but becomes a simple mechanical tube through which the fluid passes, pumped by the pharyngeal muscles. Only at the end of swallowing, after the last swallow, does the esophagus contract.
Thus, when swallowing liquid food, the pharyngeal phase is involved mainly, which, as has been said, is a reflex phase that does not obey our will. Consequently, the control over the passage of swallowed liquid food is significantly reduced compared to solid food, which explains the more frequent cases of foreign bodies of the esophagus when taking liquid food.
The given physiological information is of great importance for understanding the clinic of foreign bodies of the esophagus.
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