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Original Research: Signs and Symptoms of Chest Disease |

Characterization of the Upper Esophageal Sphincter Response During CoughUpper Esophageal Sphincter Response to Cough

Manuel Amaris, MD; Kulwinder S. Dua, MD; Sohrab Rahimi Naini, MD; Erica Samuel, MD; Reza Shaker, MD
Author and Funding Information

From the Medical College of Wisconsin Dysphagia Institute and VA Medical Center, Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI.

Correspondence to: Reza Shaker, MD, Division of Gastroenterology and Hepatology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226; e-mail: rshaker@mcw.edu


Part of this work was presented at the 18th Annual Dysphagia Research Society Annual Meeting, held on March 3-6, 2010, in San Diego, CA.

Funding/Support: This work is supported in part by National Institutes of Health [Grants 1P01DK068051-01A1 and 5RO1DK025731].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(5):1229-1236. doi:10.1378/chest.12-0638
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Background:  Vagal reflex initiated by esophageal stimulation and microaspiration can cause chronic cough in patients with gastroesophageal reflux disease (GERD). By raising intraabdominal pressure, cough can, in turn, predispose to GERD. The role of the upper esophageal sphincter (UES) in preventing esophagopharyngeal reflux during coughing is not well known. The aim of this study was to evaluate the UES response during coughing.

Methods:  We studied 20 healthy young (10 women; age, 27 ± 5 years) and 15 healthy elderly (nine women; age, 73 ± 4 years) subjects. Hard and soft cough-induced pressure changes in the UES, distal esophagus, lower esophageal sphincter, and stomach were determined simultaneously using high-resolution manometry and concurrent acoustic cough recordings.

Results:  Resting UES pressure was significantly higher in the young compared with the elderly subjects (42 ± 14 mm Hg vs 24 ± 9 mm Hg; P < .001). Cough induced a UES contractile response in all subjects. Despite lower UES resting pressures in the elderly subjects, the maximum UES pressure during cough was similar between the young and the elderly subjects (hard cough, 230 ± 107 mm Hg vs 278 ± 125 mm Hg, respectively; soft cough, 156 ± 85 mm Hg vs 164 ± 119 mm Hg, respectively; P not significant for both). The UES pressure increase over baseline during cough was significantly higher than that in the esophagus, lower esophageal sphincter, and stomach for both groups (P < .001).

Conclusions:  Cough induces a rise in UES pressure, and this response is preserved in elderly people. A cough-induced rise in UES pressure is significantly higher than that in the esophagus and stomach, thereby providing a barrier against retrograde entry of gastric contents into the pharynx.

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