The care of patients suffering from aerodigestive disorders attributed to reflux of gastric content (supraesophageal is sub-optimal. This shortcoming is for the most part due to incomplete understanding of the reflux related physiology and pathophysiology of the Pharyngo-esophageal junction and the esophagus as well lack of reliable diagnostic and effective therapeutic modalities for these common and complex conditions. Consequently the cost of current fragmented care of these patients is estimated at $54 billion annually in addition to patient suffering and diminished quality of life. There are two specific aims in this proposal:
Specific Aim A: Pathophysiology of pharyngo-esophageal junction and esophageal mechanisms preventing pharyngeal reflux of gastric content. The overall goal is to define and characterize the manometric characteristics of UES incompetence associated with objectively documented pharyngeal reflux. Studies of this aim include patients suffering from both pharyngeal reflux (regurgitation) and SE-GERD healthy controls and GERD patients without regurgitation and SE-GERD and vyill: 1. Characterize and compare the UES pressure response to liquid refluxate. 2. Determine the contribution of sub-sphincteric striated esophagus to UES pressure barrier. 3. Characterize the reflux- induced esophageal motor activity. 4. Determine and characterize the mechanisms of esophago- pharyngeal reflux.
Specific Aim B. Development of physiology- and pathophysiology-based diagnostic test and therapeutics Studies of this aim will: 1. Determine the reproducibility of manometric criteria for UES incompetence in prevention of pharyngeal reflux developed based on our preliminary data and studies of specific aim A. 2. Determine the ability of externally applied cricoid cartilage pressure in preventing pharyngeal reflux. 3. Determine and characterize the effect of externally applied cricoid cartilage pressure on related functions such as belch and swallow.

Public Health Relevance

There is no reliable diagnostic and effective therapeutic modalities for patients suffering from airway disorders attributed to reflux of gastric. The cost of current fragmented care of these patients is estimated at $54 billion annually. The overall goal of this project is to develop the manometric criteria for diagnosing UES incompetence associated with pharyngeal reflux and test the ability of externally applied cricoid cartilage pressure in preventing pharyngeal reflux.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Program Projects (P01)
Project #
2P01DK068051-06
Application #
8742108
Study Section
Special Emphasis Panel (ZDK1-GRB-6 (J1))
Project Start
Project End
Budget Start
2014-08-11
Budget End
2015-06-30
Support Year
6
Fiscal Year
2014
Total Cost
$421,658
Indirect Cost
$134,481
Name
Medical College of Wisconsin
Department
Type
DUNS #
937639060
City
Milwaukee
State
WI
Country
United States
Zip Code
53226
Jadcherla, Sudarshan (2016) Dysphagia in the high-risk infant: potential factors and mechanisms. Am J Clin Nutr 103:622S-8S
Jadcherla, Sudarshan R; Hasenstab, Kathryn A; Sitaram, Swetha et al. (2016) Effect of nasal noninvasive respiratory support methods on pharyngeal provocation-induced aerodigestive reflexes in infants. Am J Physiol Gastrointest Liver Physiol 310:G1006-14
Lang, Ivan M; Haworth, Steven T; Medda, Bidyut K et al. (2016) Mechanisms of airway responses to esophageal acidification in cats. J Appl Physiol (1985) 120:774-83
Lang, Ivan M (2016) The Physiology of Eructation. Dysphagia 31:121-33
Jadcherla, Sudarshan R; Shubert, Theresa R; Malkar, Manish B et al. (2015) Gestational and postnatal modulation of esophageal sphincter reflexes in human premature neonates. Pediatr Res 78:540-6
Jadcherla, Sudarshan R; Shubert, Theresa R; Gulati, Ish K et al. (2015) Upper and lower esophageal sphincter kinetics are modified during maturation: effect of pharyngeal stimulus in premature infants. Pediatr Res 77:99-106
Jadcherla, Sudarshan R; Hasenstab, Kathryn A; Shaker, Reza et al. (2015) Mechanisms of cough provocation and cough resolution in neonates with bronchopulmonary dysplasia. Pediatr Res 78:462-9
Babaei, Arash; Venu, Mukund; Naini, Sohrab Rahimi et al. (2015) Impaired upper esophageal sphincter reflexes in patients with supraesophageal reflux disease. Gastroenterology 149:1381-91
Hanin, Melissa; Nuthakki, Sushma; Malkar, Manish B et al. (2015) Safety and Efficacy of Oral Feeding in Infants with BPD on Nasal CPAP. Dysphagia 30:121-7
Madhoun, Lauren L; Siler-Wurst, Kimberly K; Sitaram, Swetha et al. (2015) Feed-Thickening Practices in NICUs in the Current Era: Variability in Prescription and Implementation Patterns. J Neonatal Nurs 21:255-262

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