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
Mei, Ling; Dua, Arshish; Kern, Mark et al. (2018) Older Age Reduces Upper Esophageal Sphincter and Esophageal Body Responses to Simulated Slow and Ultraslow Reflux Events and Post-Reflux Residue. Gastroenterology 155:760-770.e1
Jiao, Hongmei; Mei, Ling; Liang, Chenyang et al. (2018) Upper esophageal sphincter augmentation reduces pharyngeal reflux in nasogastric tube-fed patients. Laryngoscope 128:1310-1315
Agrawal, D; Kern, M; Edeani, F et al. (2018) Swallow strength training exercise for elderly: A health maintenance need. Neurogastroenterol Motil 30:e13382
Levy, Deborah S; Osborn, Erika; Hasenstab, Kathryn A et al. (2018) The Effect of Additives for Reflux or Dysphagia Management on Osmolality in Ready-to-Feed Preterm Formula: Practice Implications. JPEN J Parenter Enteral Nutr :
Hasenstab, Kathryn A; Sitaram, Swetha; Lang, Ivan M et al. (2018) Maturation Modulates Pharyngeal-Stimulus Provoked Pharyngeal and Respiratory Rhythms in Human Infants. Dysphagia 33:63-75
Jadcherla, Sudarshan R; Prabhakar, Varsha; Hasenstab, Kathryn A et al. (2018) Defining pharyngeal contractile integral during high-resolution manometry in neonates: a neuromotor marker of pharyngeal vigor. Pediatr Res 84:341-347
Lang, Ivan M; Medda, Bidyut K; Shaker, Reza et al. (2018) The effect of body position on esophageal reflexes in cats: a possible mechanism of SIDS? Pediatr Res 83:731-738
Jadcherla, Sudarshan R (2017) Advances with Neonatal Aerodigestive Science in the Pursuit of Safe Swallowing in Infants: Invited Review. Dysphagia 32:15-26
Mei, Ling; Jiao, Hongmei; Sharma, Tarun et al. (2017) Comparative effect of the sites of anterior cervical pressure on the geometry of the upper esophageal sphincter high-pressure zone. Laryngoscope 127:2466-2474
Kern, Mark K; Balasubramanian, Gokulakrishnan; Sanvanson, Patrick et al. (2017) Pharyngeal peristaltic pressure variability, operational range, and functional reserve. Am J Physiol Gastrointest Liver Physiol 312:G516-G525

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