In the infant population, the complex issues of dysphagia and swallowing remain to be a conundrum when it comes to the care management of this population. The lack of a pathophysiology guided diagnostic and safe feeding management strategies continue to be critical barriers to progress in this field. This proposal will focus on the dynamic changes in the integrative physiology of the neonatal pharynx, upper esophageal sphincter (UES), lower esophageal sphincter (LES) and esophagus during swallowing and GERD. The overall goal of this project is to examine new management approaches of dysphagia in the infant population. This project will address two aims.
Aim 1 : Effectiveness of two feeding strategies on clinical-, safety- and economic- outcomes in dysphagic infants with anterograde aspiration. The goal of this Aim is to develop novel feeding strategies, to improve clinical outcomes and to clarify aerodigestive protective mechanisms in oral-fed infants (under 6 months of age) with abnormalities proven by diagnostic video fluroscopy swallow study (VFSS).
Aim 2 : Mechanisms and Impact of feeding strategies on pharyngeal and esophageal sensitivity of aerodigestive reflexes in dysphagia with or without GERD. The goal of this Aim is to differentiate GERD and its consequences by examining the sensory-motor characteristics of the swallow, various reflexes and aero-digestive coordination using manometric studies.

Public Health Relevance

Current treatment approaches in dysphagic infants aren't likely to be successful because no clear target has been determined. These infants typically also suffer from chronic morbidity, longer hospitalizations, re- admission, and account for an unacceptable health care burden and or anti-GERD therapies. Upon the completion of this project, we hope to have better diagnostic biomarkers and improved feeding management strategies for a better quality of life for both the infant and parents.

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 #
8742109
Study Section
Special Emphasis Panel (ZDK1-GRB-6 (J1))
Project Start
Project End
Budget Start
2014-04-01
Budget End
2015-03-31
Support Year
6
Fiscal Year
2014
Total Cost
$383,851
Indirect Cost
Name
Medical College of Wisconsin
Department
Type
DUNS #
937639060
City
Milwaukee
State
WI
Country
United States
Zip Code
53226
Shaker, Reza; Babaei, Arash; Naini, Sohrab R (2014) Prevention of esophagopharyngeal reflux by augmenting the upper esophageal sphincter pressure barrier. Laryngoscope 124:2268-74
Lang, Ivan M; Medda, Bidyut K; Babaei, Arash et al. (2014) Role of peripheral reflexes in the initiation of the esophageal phase of swallowing. Am J Physiol Gastrointest Liver Physiol 306:G728-37
Dua, Kulwinder S; Surapaneni, Sri Naveen; Kuribayashi, Shiko et al. (2014) Effect of aging on hypopharyngeal safe volume and the aerodigestive reflexes protecting the airways. Laryngoscope 124:1862-8
Hasenstab, Kathryn A; Jadcherla, Sudarshan R (2014) Respiratory events in infants presenting with apparent life threatening events: is there an explanation from esophageal motility? J Pediatr 165:250-255.e1
Babaei, Arash; Dua, Kulwinder; Naini, Sohrab Rahimi et al. (2012) Response of the upper esophageal sphincter to esophageal distension is affected by posture, velocity, volume, and composition of the infusate. Gastroenterology 142:734-743.e7
Dua, Kulwinder; Surapaneni, Sri Naveen; Kuribayashi, Shiko et al. (2011) Protective role of aerodigestive reflexes against aspiration: study on subjects with impaired and preserved reflexes. Gastroenterology 140:1927-33
Dua, Kulwinder; Surapaneni, Sri Naveen; Kuribayashi, Shiko et al. (2011) Pharyngeal airway protective reflexes are triggered before the maximum volume of fluid that the hypopharynx can safely hold is exceeded. Am J Physiol Gastrointest Liver Physiol 301:G197-202
Hernandez, Lyndon V; Dua, Kulwinder S; Surapaneni, Sri Naveen et al. (2010) Anatomic-manometric correlation of the upper esophageal sphincter: a concurrent US and manometry study. Gastrointest Endosc 72:587-92
Jadcherla, S R; Wang, M; Vijayapal, A S et al. (2010) Impact of prematurity and co-morbidities on feeding milestones in neonates: a retrospective study. J Perinatol 30:201-8
Jadcherla, Sudarshan R; Hogan, Walter J; Shaker, Reza (2010) Physiology and pathophysiology of glottic reflexes and pulmonary aspiration: from neonates to adults. Semin Respir Crit Care Med 31:554-60

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