Bolus Head Research Articles

Thin Liquid Bolus Volume Alters Pharyngeal Swallowing: Kinematic Analysis Using 3D Dynamic CT.

The previous studies reported that different volumes of thick liquid had an impact on spatiotemporal characteristics and pharyngeal response of swallowing. However, the bolus flow and swallowing motion pattern were different between thick and thin liquids. The effects of thin bolus volume on pharyngeal swallowing, especially true vocal cord (TVC) closure is still unclear. This study assessed the temporal characteristics when swallowing different volumes of thin liquid to determine the mechanical adaptation using 320-row area detector computed tomography (320-ADCT) and investigated a change of swallowing physiology including laryngeal closure, particularly TVC closure. Fourteen healthy women (28-45years) underwent 320-ADCT while swallowing of 3, 10, and 20ml of thin liquid barium in 45° semi-reclining position. Kinematic analysis was performed for each swallow including temporal characteristic, structural movements while swallowing, and maximal cross-sectional area of the upper esophageal sphincter (UES) opening. Bolus head reached to pharynx and esophagus earlier in larger volume significantly, indicating faster bolus transport as volume increased. There were significant effects on swallowing mechanism revealing earlier TVC closure and UES opening with increasing volume. Maximum cross-sectional area of the UES opening was increased to accommodate a larger bolus. Differences in mechanical adaptation through bolus transit and motion of swallowing structures were detected across increasing volumes. These volume-dependent adaptations potentially reduce the risk of aspiration. Understanding the swallowing physiological changes as volume increased is helpful for diagnosis and treatment of dysphagia patients as well as outcomes of swallowing rehabilitation in clinical practice.

Influence of Thermal and Gustatory Stimulus in the Initiation of the Pharyngeal Swallow and Bolus Location Instroke

Introduction/ObjectiveThe aim of this study is to analyze the influence of sour taste and cold temperature in the initiation of the pharyngeal swallow (IPS) and bolus location at pharyngeal swallow onset in individuals after stroke. MethodsCross-sectional prospective study. The study included 52 individuals with unilateral ischemic stroke. Each individual was assessed by videofluoroscopic swallowing study with 5ml of paste bolus offering four different stimuli (natural, cold, sour, and sour-cold). The individuals were divided into two groups according to the offer sequence. Group 1 (G1) – received a randomized sequence of stimuli (24 individuals), and Group 2 (G2) –the stimuli were offered in the following order: natural, cold, sour, and sour-cold(28 individuals). The IPS time and bolus location at pharyngeal swallow onset were analyzed. The bolus location at pharyngeal swallow onset was defined using six different levels. ResultsIndividuals in G1 did not show a significant difference in IPS time between stimuli. However, individuals in G2 presented a significantly shorter IPS time with the sour and sour-cold stimuli than with natural or cold stimuli. The bolus location at pharyngeal swallow onset did not show significant difference between stimuli in both groups. On the other hand, in the G2 it was observed higher frequency of swallowing with sour-cold stimulus at level 1 (the bolus head was located in any region between the fauces pillar and the point where the tongue crosses the inferior border of the mandible). ConclusionThe sour and sour-cold stimuli influenced the IPS time when they were offered in a sequential order. Moreover, both the IPS time and bolus location at pharyngeal swallow onset were not influenced by the sour and sour cold-bolus when offered in a random sequence.

Factors Influencing Initiation of Pharyngeal Swallow in Healthy Adults.

Purpose The purpose of this study was to investigate factors influencing the initiation of pharyngeal swallow (IPS) in healthy, nondysphagic adults. Method A total of 195 healthy participants ranging in age from 21 to 89 years participated in a modified barium swallow study. IPS was quantified using the Modified Barium Swallow Impairment Profile standardized scoring system across nine swallowing tasks observed in the lateral viewing plane for each participant. Results Large variability for bolus head location at time of hyoid burst (IPS) was observed within this healthy cohort, ranging from the ramus of the mandible to the pyriform sinuses. Significant effects of bolus volume, viscosity, sex, and race were also observed. Conclusion Study findings indicate that IPS is variable in healthy adults and influenced by volume, viscosity, sex, and race. Thus, variability in IPS may be considered typical in otherwise nondysphagic adults. The clinical significance of high Modified Barium Swallow Impairment Profile IPS scores in dysphagic patients, therefore, must be considered within the context of other swallowing impairments. Supplemental Material https://doi.org/10.23641/asha.12735935.

The effect of reclining position on swallowing function in stroke patients with dysphagia.

Dysphagia is a common problem in patients with a history of stroke. In Japan, a reclined position is commonly used as a compensatory technique to address this problem. To evaluate the effect of reclined position on swallowing function in patients with stroke who had dysphagia. A retrospective analysis was carried out on the videofluoroscopic examination of swallowing (VF) of 4ml honey-thick liquid swallows collected over 9years. Penetration-aspiration scale (PAS) and residue scores were compared for the following: a body position at 90° upright (90°U) and 60° reclining (60°R) groups, as well as 60°R and 45° reclining (45°R) groups. Two hundred and five records from 98 subjects were reviewed. These included patients with ischaemic stroke (62%), haemorrhagic stroke (32%) and subarachnoid haemorrhage (6%). PAS scores were lower when the body was in a more reclined position (P<.001). The amount of residue in the valleculae and pyriform sinus also reduced in the more reclined position (P<.001). The deeper bolus head at swallowing onset was positively correlated with severe PAS (P<.001). These findings suggest that in patients with stroke who had dysphagia, a reclined position may be useful in reducing the risk of penetration and aspiration, and in decreasing the amount of residue in the pharyngeal area. The depth of the bolus head at the onset of swallowing increases the severity of penetration and aspiration.

Simultaneous Radiological and Fiberendoscopic Evaluation of Swallowing (\u201cSIRFES\u201d) in Patients After Surgery of Oropharyngeal/Laryngeal Cancer and Postoperative Dysphagia

To compare the results of a simultaneously performed videofluoroscopic swallowing study and fiberendoscopic evaluation of swallowing in patients with dysphagia after surgery and radiotherapy for oropharyngeal or laryngeal cancer. This prospective study included 31 patients who were examined simultaneously with a standardized protocol. The fiberendoscopic and videofluoroscopic swallowing loops were independently scored by two otorhinolaryngologists/phoniatricians and two radiologists. The presence of penetration/aspiration, the amount of pharyngeal residues and the position of the bolus head when triggering of pharyngeal swallow begins were evaluated. Generalized linear models were used to model the impact of rater, method, bolus and quantities as well as specified moderation effects on scorings. In addition, post hoc Wilcoxon tests were used. Rater agreement was assessed using weighted kappas and their 95% confidence intervals. A total of 202 swallow sequences in 29 patients was evaluated. Interrater agreement was substantial to excellent for both methods (weighted k = 0.979–0.613). Significant differences between both methods were found when assessing the penetration-aspiration scale (p = 0.001, tendency of higher scores by videofluoroscopic (median = 2.59) as opposed to fiberendoscopic (median = 2.14) and the residue severity scores in the valleculae (p = 0.029) and the sinus piriformes (p = 0.002) with larger residues scored by fiberendoscopic evaluation of swallowing. No significant differences were found regarding the time point of triggering (p = 0.273). Simultaneous evaluation of swallowing with FEES and VFSS showed significantly different results in symptomatic patients after tumor operation and radiotherapy.

Changes in Hyolaryngeal Movement During Swallowing in the Lateral Decubitus Posture.

ObjectiveTo investigate the differences in hyolaryngeal kinematics at rest and during swallowing in the upright sitting (UP) and the lateral decubitus (LD) postures in healthy adults, and delineating any potential advantages of swallowing while in the LD posture.MethodsSwallowing was videofluoroscopically evaluated in 20 healthy volunteers in UP and LD postures, based on the movements of hyoid bone, vocal folds, and the bolus head. Parameters included the Penetration-Aspiration Scale (PAS), horizontal and vertical displacement, horizontal and vertical initial position, horizontal and vertical peak position, time to peak position of the hyoid bone and vocal folds, and pharyngeal transit time (PTT).ResultsNine participants were rated PAS 2 in the UP and 1 was rated PAS 2 in the LD (p=0.003) at least 1 out of 3 swallows each posture. The hyoid and vocal folds showed more anterior and superior peak and initial positions in the LD. In addition, swallowing resulted in greater vertical and smaller horizontal displacement of the hyoid in LD posture compared with UP. Time to peak position of the hyoid was shorter in LD. The maximal vertical and horizontal displacement of the vocal folds, and PTT were comparable between postures.ConclusionThe results showed that the peak and initial positions of the hyoid and larynx and the pattern of hyoid movement varied significantly depending on the body postures. This study suggests that the LD posture was one of the safe feeding postures without any increased risk compared with UP posture.

Position of Bolus Head at the Onset of Swallowing of Paste Food in Patients with Severe Motor Intellectual Disabilities

Position of Bolus Head at the Onset of Swallowing of Paste Food in Patients with Severe Motor Intellectual Disabilities

The effect of bolus volume on laryngeal closure and UES opening in swallowing: Kinematic analysis using 320-row area detector CT study.

This study investigated the effects of three different volumes of honey-thick liquid on the temporal characteristics of swallowing. Twenty-six healthy subjects (15 males, 11 females) underwent 320-row area detector CT scan while swallowing 3, 10 and 20mL of honey-thick liquid barium. Three-dimensional images were created at 10images/s. Kinematic events involving six structures (velopharynx, hyoid bone, epiglottis, laryngeal vestibule (LV), true vocal cords (TVC), upper esophageal sphincter (UES)) and timing of bolus movement were timed using frame by frame analysis. The overall sequence of events did not differ across three volumes; however, increasing bolus volume significantly changed the onset and termination of events. The bolus head reached to pharynx and esophagus earlier and the duration of bolus passing through UES was significantly longer in 10 and 20mL compared to 3mL (P<.05). Consequently, the onset of UES opening was significantly earlier with increased volume (P<.05). LV and TVC closure occurred later in 20mL compared to 3mL (P<.05). These changes in motion of pharynx and larynx appeared to promote swallow safety by preventing aspiration, suggesting that anatomical structure movements adapt in response to bolus volume. Our findings also suggest that the pharyngeal swallow behaviours may be modified by afferents in the oral cavity. The three-dimensional visualization and quantitative measurements provided by 320-ADCT provide essential benchmarks for understanding swallowing, both normal and abnormal.

Numerical analysis of extensional flow through the pharyngeal duct

The flow through the pharynx from the glossopalatal junction (GPJ) to the upper esophageal sphincter (UES) has been numerically investigated with a non-Newtonian fluid obeying the power-law with similar rheological indices to a contrast medium used in videofluroscopy. For that purpose, a three-dimensional model of the transport of food bolus along the pharynx has been proposed using the immersed boundaries method, which allow representing the shape of the pharynx using Cartesian grids. The pharyngeal wall has been considered to be an elastic membrane. Flow fields in terms of the axial velocity, pressure, shear rate and strain rate were obtained. Results show that the highest velocity concentrates in the central stream as the fluid enters into the pharynx. In addition, as the flow quits the pharynx, a recirculation zone appears inside the cavity, resulting in low velocity zone, which increases with the coefficient of elasticity. A strong dependence on the coefficient of elasticity was observed on the pressure fields; so that as such a coefficient increases, the pressure in the pharyngeal wall will increase. It has been also observed that the bolus head travels faster than the bolus tail, which indicates that the bolus is not only subjected to shear but also to elongation. Results from this work can be further used for a rheological characterization (shear and extension) of oral nutritional supplements for patients suffering from swallowing disorders.

Effect of body posture on involuntary swallow in healthy volunteers

Clinically, reclining posture has been reported to reduce risk of aspiration. However, during involuntary swallow in reclining posture, changes in orofacial and pharyngeal movement before and during pharyngeal swallow should be considered. Further, the mechanisms underlying the effect of body posture on involuntary swallow remain unclear. The aim of the present study was to determine the effect of body posture on activity patterns of the suprahyoid muscles and on patterns of bolus transport during a natural involuntary swallow. Thirteen healthy male adults participated in a water infusion test and a chewing test. In the water infusion test, thickened water was delivered into the pharynx at a very slow rate until the first involuntary swallow was evoked. In the chewing test, subjects were asked to eat 10g of gruel rice. In both tests, the recording was performed at four body postures between upright and supine positions. Results showed that reclining changed the location of the bolus head at the start of swallow and prolonged onset latency of the swallowing initiation. Muscle burst duration and whiteout time measured by videoendoscopy significantly increased with body reclining and prolongation of the falling time. In the chewing test, reclining changed the location of the bolus head at the start of swallow, and the frequency of bolus residue after the first swallow increased. Duration and area of EMG burst and whiteout time significantly increased with body reclining. These data suggest that body reclining may result in prolongation of pharyngeal swallow during involuntary swallow.

The Sequence of Swallowing Events During the Chin-Down Posture.

This study investigated the effect of the chin-down posture on the sequence of swallowing events in healthy adults. Sixteen healthy participants performed 45 5-ml thin liquid swallows during videofluoroscopy: 5 neutral head position, 30 chin-down posture, and then 10 neutral head position. Eight swallowing events were measured: the time of hyoid burst, bolus head in the pharynx, bolus tail in the pharynx, laryngeal vestibule closure (LVC), upper esophageal sphincter (UES) opening, bolus head in the UES, bolus tail exiting the pharynx, and laryngeal vestibule opening (LVO). Our key finding is that LVC was one of the first 3 swallowing events in 69% of neutral swallows and in 78% of chin-down swallows (p = .006). Also, LVO occurred last in 14% of chin-down swallows but never occurred last in the preceding neutral swallows (p ≤ .001). Thus, in chin-down swallows, LVC occurred earlier and LVO occurred later. The chin-down posture may be beneficial for individuals with delayed onset of LVC and reduced duration of the LVC. Future studies are needed to examine this effect in individuals with dysphagia.

Temporal characteristics of hyolaryngeal structural movements in normal swallowing.

To evaluate the relationship between movements of hyolaryngeal structures and fluid bolus transition in normal swallowing using automatized kinematic analysis of the videofluoroscopic swallowing study (VFSS). A prospective, descriptive study. Seventy-five healthy volunteers underwent VFSS with 2 mL of diluted barium. The timing and sequence of structural movements were measured for laryngeal elevation (LE), hyoid excursion (HE), epiglottic rotation (ER), and fluid bolus transition. The rapid movement of LE (reference time point) was initiated simultaneously with the fluid bolus head passing the mandibular angle (-0.05 s, P = .07), followed by rapid onset of HE with significant temporal difference (P < .001). After the hyoid onset, onset of ER (0.17 s, P < .001), entrance of the bolus through upper esophageal sphincter (0.33 s, P < .001), maximal point of LE (0.52 s, P < .001), HE (0.53 s, P = .344), and maximal point of ER (0.64 s, P < .001) followed sequentially. For subgroup analysis, we classified 50 subjects without premature bolus loss (PBL) or pharyngeal triggering delay (PTD) into the "early group," and 24 subjects with PBL or PTD for <1 s into the "late group." In both groups, the sequence of the structural movements did not change. The early group showed significant correlation between the fluid transition and structural movements; both LE and HE were initiated when the bolus passed the mandibular angle, and the ER was initiated when the bolus reached the vallecula. We demonstrated a characteristic pattern of hyolaryngeal structural movements in normal swallowing. The results may serve as a basis for classifying and analyzing aspiration patterns in patients with dysphagia. NA.

Effect of swallowed bolus viscosity and body position on esophageal transit, contraction and perception of transit.

The esophagus has a different response in relation to the characteristics of a swallowed bolus. Bolus viscosity and body position may affect esophageal contraction and transit. Objectives To investigate the effect of bolus viscosity and body position on esophageal contraction, transit and perception. Esophageal contraction, transit and perception of transit were evaluated in 26 asymptomatic volunteers, 13 men and 13 women aged 18-60 years, mean: 33.6 (12.2) years. Esophageal contraction (manometry) and transit (impedance) were measured with a solid state catheter with sensors located 5, 10, 15, and 20 cm from the lower esophageal sphincter. Each volunteer swallowed in duplicate and in random sequence a 5 mL low viscous (LV) liquid bolus of an isotonic drink with pH 3.3, and a 5 mL high viscous (HV) paste bolus, which was prepared with 7.5 g of instant food thickener diluted in 50 mL of water (pH: 6.4). Total bolus transit time, in the sitting position, was longer with the HV bolus than with the LV bolus. Esophageal transit was longer in the supine position than in the sitting position. Bolus head advance time was longer with the HV bolus than with the LV bolus in both positions. Contraction esophageal amplitude was higher in the supine position than in the sitting position. The perception of bolus transit was more frequent with the HV bolus than with the LV bolus, without differences related to position. The viscosity of the swallowed bolus and body position during swallows has an influence on esophageal contractions, transit and perception of transit.

Esophageal Bolus Transit in Newborns with Gastroesophageal Reflux Disease Symptoms: A Multichannel Intraluminal Impedance Study.

PurposeThe aim of this study was to evaluate bolus transit during esophageal swallow (ES) and gastroesophageal reflux (GER) events and to investigate the relationship between the characteristics of ES and GER events in a population of term and preterm newborns with symptoms of gastroesophageal reflux disease (GERD).MethodsThe study population consisted of term and preterm newborns referred to combined multichannel intraluminal impedance (MII) and pH monitoring for GERD symptoms. The frequency and characteristics of ES and GER events were assessed by two independent investigators. Statistical significance was set at p<0.05.ResultsFifty-four newborns (23 preterm) were included in the analyses. Median bolus head advancing time corrected for esophageal length (BHATc) was shorter during mealtime than during the postprandial period (median, interquartile range): 0.20 (0.15-0.29) s/cm vs. 0.47 (0.39-0.64) s/cm, p<0.001. Median bolus presence time (BPT) was prolonged during mealtime: 4.71(3.49-6.27) s vs. 2.66 (1.82-3.73) s, p<0.001. Higher BHATc (p=0.03) and prolonged BPT (p<0.001) were observed in preterm newborns during the postprandial period. A significant positive correlation between BHATc and bolus clearance time was also observed (ρ=0.33, p=0.016).ConclusionThe analysis of ES and GER events at the same time by MII provides useful information to better understand the physiopathology of GERD. In particular, the analysis of BHATc during the postprandial period could help clinicians identify newborns with prolonged esophageal clearance time due to impaired esophageal motility, which could allow for more accurate recommendations regarding further tests and treatment.

Early Numerical Studies on the Peristaltic Flow through the Pharynx

AbstractThe flow through the pharynx from the GPJ to the UES has been numerically investigated with a non‐Newtonian fluid obeying the power law with similar rheological indices to a contrast medium used in videofluroscopy. Flow fields revealed the occurrence of reflux regions in the beginning, being this effect stronger at low entrance pressure, which could be related to abnormal swallowing. As a consequence, the bolus travels preferably along the walls. It has been also observed that the bolus head travels faster than the bolus tail, which indicates that the bolus is elongated. Results from this work can be further used for a rheological characterization of oral nutritional supplements for patients suffering from swallowing disorders.Practical ApplicationsThe flow through the pharynx has been numerically investigated with a non‐Newtonian fluid to get insight about causes leading to abnormal swallowing. Reflux has been observed in the beginning as result of a central stream and two symmetric loops generated along the walls, being this effect at low peristaltic pressure. Velocity fields revealed that the bolus head travels faster than the bolus tail, which is a result of the geometry and conservation of mass. Under these conditions, extensional stresses are generated by the flexion of the pharynx walls. Shear rate fields allowed establishing the shear rate range at which the bolus is subjected along the pharynx, which is useful for the rheological characterization of supplements for patients suffering from swallowing disorders.

ESOPHAGEAL MOTILITY IN TROUBLESOME BELCHING

Supragastric belches are the main determinants of troublesome belching symptoms. In supragastric belches, air is rapidly brought into the esophagus and is immediately followed by a rapid expulsion before it has reached the stomach. To evaluate the esophageal contraction and transit after wet swallows in patients with troublesome belching. Esophageal contraction and transit were evaluated in 16 patients with troublesome belching and 15 controls. They were measured at 5, 10, 15, and 20 cm from the lower esophageal sphincter (LES) by a solid state manometric and impedance catheter. Each subject swallowed five 5 mL boluses of saline. The amplitude, duration and area under the curve of contractions were similar in patients with troublesome belching and control subjects. The total esophageal bolus transit time was 6.2 (1.8) s in patients with troublesome belching and 6.1 (2.3) s in controls (P=0.55). The bolus presence time was longer in controls than in patients at 5 cm from the LES [controls: 6.0 (1.1) s, patients: 4.9 (1.2) s, P=0.04], without differences at 10, 15 and 20 cm from the LES. The bolus head advanced time was longer in patients than controls from 20 cm to 15 cm [controls: 0.1 (0.1) s, patients: 0.7(0.8)s, P=0.01] and from 15 cm to 10 cm [controls: 0.3 (0.1) s, patients: 1.6 (2.6) s, P=0.01] of the LES, without difference from 10 cm to 5 cm [controls: 0.7 (0.3) s, patients: 1.0 (1.1) s, P=0.37]. There was no difference in segment transit time. There was no difference in esophageal contractions between patients with troublesome belching and controls. The swallowed bolus went slower into the proximal and middle esophageal body in patients than in control, but cross the distal esophageal body faster in patients than in controls.

Preterm Infant Swallowing of Thin and Nectar-Thick Liquids: Changes in Lingual–Palatal Coordination and Relation to Bolus Transit

Tongue-soft palate coordination and bolus head pharyngeal transit were studied by means of postacquisition kinematic analysis of videofluoroscopic swallowing images of ten preterm infants referred from hospital NICUs due to poor oral feeding and suspicion of aspiration. Sequences of coordinated tongue-soft palate movements and bolus transits during swallows of thin-consistency and nectar-thick-consistency barium were digitized, and time series data were used to calculate continuous relative phase, a measure of coordination. During swallows of nectar-thick compared to thin barium, tongue-soft palate coordination was more likely to be antiphase, bolus head pharyngeal transit time was longer, and coordination was significantly correlated with bolus head pharyngeal transit. Analysis of successive swallows indicated that tongue-soft palate coordination variability decreased with nectar-thick but not with thin-consistency barium. Together, the results suggest that slower-moving bolus transits may promote greater opportunity for available sensory information to be used to modulate timing of tongue-soft palate movements so that they are more effective for pumping liquids.

Biomechanics of human tongue movement during bolus compression and swallowing

We evaluated the effects of gel consistency and bolus volume on ingestion in humans. Eight healthy men were asked to ingest liquids, and sample foods of different gel consistencies and volumes, as usual. Tongue pressure against the hard palate was recorded at five points, and bolus flow was recorded using videoendoscopic images. The number of squeezes increased as gel consistency and volume increased. The integrated magnitude of tongue pressure during squeezing increased with increasing gel consistency. Bolus propulsion into the pharynx was affected by bolus characteristics, and location of the bolus head at the onset of pharyngeal swallowing was not related to squeezing behavior. The trigger point at which pharyngeal swallowing began was subject-dependent. During swallowing, the magnitude of tongue pressure moderately increased with increasing gel consistency, as compared with squeezing. Tongue pressure was not related to bolus volume. The current results suggest that patterns of tongue pressure during squeezing and swallowing are differentially affected by bolus conditions. However, healthy subjects differed in the techniques used for squeezing and swallowing.

714 Relationship Between Esophageal Swallow Patterns and Reflux Characteristics in Newborns with Symptoms of Gastroesophageal Reflux Disease

Background and AimsTransient lower esophageal sphincter relaxations are primarily responsible for GER in healthy infants and plays an important role in preterm and term infants with GER disease (GERD). Gastroesophageal...

Esophageal Bolus Transit in Newborn with Gastroesophageal Reflux

Background and aim: Gastroesophageal dismotility due to immaturity is primarily involved in the pathogenesis of gastroesophageal reflux (GER) in newborns. Impaired swallowing patterns could influence refluxes characteristics and esophageal acid exposure. Multichannel Intraluminal Impedance (MII) is a novel technique to evaluate GER, and it has been used to evaluate esophageal bolus transit in adults and children, but data on its use in newborns are scanty.The aim of this study was to investigate the relation between esophageal motor disfunction and GER.Methods: Esophageal bolus transit was evaluated in 16 term newborns aged 15-30 days, who underwent 24h-pH/MII analysis for clinical suspect of GER disease. Eight patients had ≥5% time with esophageal pH< 4 (GER positive) and the other 8 patients had < 5% time with esophageal pH< 4 (GER negative). Bolus Head Advance Time (BHAT) and Total Bolus Transit Time (TBTT) were assessed on 3-hours intervals of MII recording.Results: BHAT and TBTT were calculated on a total of 1056 swallowing events MII detected. Table 1 Table Bolus Transit time analysis results.Full size table BHAT and TBTT observed during meal were shorter than in the fasting periods in both groups (p< 0.001). During meal, TBTT, but not BHAT, was longer (p=0.03) in the GER positive than in the GER negative group.Conclusions: Our results support that esophageal motor disfunction contributes to the pathogenesis of GER in newborns, impairing esophageal clearance.