Deglutition

Deglutition, commonly known as swallowing, is the process by which food and liquids are
moved from the mouth to the stomach. It involves a complex series of coordinated muscular
movements and neural signals to ensure that ingested material is safely transported through
the esophagus without entering the airway. Deglutition can be divided into three main
phases:

1. Oral Phase:
- The oral phase begins with the voluntary placement of food or liquid into the mouth.
- Chewing (mastication) breaks down food into smaller pieces, mixing it with saliva to form
a bolus (a cohesive mass of food).
- The tongue pushes the bolus towards the back of the mouth (oropharynx), triggering the
initiation of the next phase.

2. Pharyngeal Phase:
- The pharyngeal phase is involuntary and reflexive, triggered when the bolus reaches the
back of the mouth.
- The soft palate elevates to prevent food from entering the nasal passages.
- The larynx elevates and the epiglottis folds down to cover the entrance to the trachea
(windpipe), diverting the bolus towards the esophagus and away from the airway.
- The pharyngeal muscles contract, propelling the bolus downward through the pharynx
and into the esophagus.
- This phase involves the coordination of various cranial nerves, including the
glossopharyngeal nerve (IX), vagus nerve (X), and hypoglossal nerve (XII).

Deglutition apnea, also known as swallowing apnea or deglutition-induced apnea, refers to

a temporary cessation of breathing that occurs during the act of swallowing. This
phenomenon is a normal physiological response that helps protect the airway during
swallowing.

During deglutition, the upper airway needs to be protected to prevent food or liquid from
entering the trachea and lungs (aspiration). To achieve this, the body employs several
mechanisms, one of which is deglutition apnea. When the swallow reflex is triggered, signals
are sent to the brainstem, which in turn inhibits the respiratory centers temporarily, leading
to a pause in breathing. This pause allows the upper airway structures, such as the larynx
and vocal folds, to close off, preventing aspiration of food or liquid into the lungs.

Deglutition apnea typically lasts for a very brief duration, usually less than 2 seconds in
healthy individuals. However, in certain medical conditions or swallowing disorders,
deglutition apnea may be prolonged or disrupted, leading to difficulties with swallowing and
an increased risk of aspiration.

Overall, deglutition apnea is an important protective mechanism that ensures the safe
passage of food and liquids through the digestive tract while minimizing the risk of
aspiration into the respiratory system.
3. Esophageal Phase:
- The esophageal phase involves the transit of the bolus through the esophagus and into
the stomach.
- Peristaltic waves of muscular contraction move sequentially along the esophagus,
pushing the bolus downwards.
- The lower esophageal sphincter relaxes to allow the bolus to enter the stomach, and then
contracts to prevent reflux of stomach contents back into the esophagus.

Following the completion of these phases, digestion and absorption of nutrients occur in the
stomach and intestines. Dysfunction in any of the phases of deglutition can lead to
swallowing difficulties (dysphagia), which may result in aspiration of food or liquid into the
airway, malnutrition, or other complications. Assessment and management of swallowing
disorders often involve a multidisciplinary approach, including speech-language pathologists,
otolaryngologists, gastroenterologists, and other healthcare professionals.
Achalasia is a rare disorder that makes it difficult for food and liquid to pass from the
swallowing tube connecting your mouth and stomach (esophagus) into your stomach.
Inability to swallow (dysphagia), which may feel like food or drink is stuck in your throat

Symptoms & signs

• Regurgitating food or saliva

• Heartburn
• Belching
• Chest pain that comes and goes
• Coughing at night
• Pneumonia (from aspiration of food into the lungs)
• Weight loss
• Vomiting