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  • Review Article
  • Published:

Upper gastrointestinal motility: prenatal development and problems in infancy

Nature Reviews Gastroenterology & Hepatology volume 11, pages 545–555 (2014)Cite this article

Subjects

Key Points

  • Deglutition is the act or process of swallowing and is one of the most complex reflex neural activities, involving the highly coordinated interplay of swallowing and breathing

  • By 34 weeks gestational age, most neonates are capable of successful sucking and swallowing if born at this early stage; however, the respiratory system is not yet fully established at this point

  • In healthy preterm neonates, swallow-induced (primary) peristalsis and peristalsis elicited by oesophageal distension (secondary) can be identified as the chief mechanisms of bolus clearance at 26 and 32 weeks gestational age, respectively

  • A swallowing disorder is defined as difficulty swallowing; key symptoms in infancy are excessive regurgitation, food refusal, choking and gagging, and chronic and/or recurrent respiratory symptoms

  • Gastro-oesophageal reflux is predominantly caused by transient relaxation of the lower oesophageal sphincter, which can develop into GERD due to multiple factors (for example, insufficient clearance and buffering of refluxate)

  • Although survival rates in patients with oesophageal atresia are high, surgical complications and long-term oesophageal morbidities, which are mainly related to oesophageal motility disorders, occur in almost all patients

Abstract

Deglutition, or swallowing, refers to the process of propulsion of a food bolus from the mouth into the stomach and involves the highly coordinated interplay of swallowing and breathing. At 34 weeks gestational age most neonates are capable of successful oral feeding if born at this time; however, the maturation of respiration is still in progress at this stage. Infants can experience congenital and developmental pharyngeal and/or gastrointestinal motility disorders, which might manifest clinically as gastro-oesophageal reflux (GER) symptoms, feeding difficulties and/or refusal, choking episodes and airway changes secondary to micro or overt aspiration. These problems might lead to impaired nutritional intake and failure to thrive. These gastrointestinal motility disorders are mostly classified according to the phase of swallowing in which they occur, that is, the oral preparatory, oral, pharyngeal and oesophageal phases. GER is a common phenomenon in infancy and is referred to as GERD when it causes troublesome complications. GER is predominantly caused by transient relaxation of the lower oesophageal sphincter. In oesophageal atresia, oesophageal motility disorders develop in almost all patients after surgery; however, a congenital origin of disordered motility has also been proposed. This Review highlights the prenatal development of upper gastrointestinal motility and describes the most common motility disorders that occur in early infancy.

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Figure 1: The four phases of swallowing.
Figure 2: The link between oesophageal atresia and dysmotility.

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Authors and Affiliations

  1. Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands

    Maartje M. J. Singendonk, Marc A. Benninga & Michiel P. van Wijk

  2. Department of Neurosciences, ExpORL, KU Leuven, O&N II Herenstraat 49, Box 721, Leuven, 3000, Belgium

    Nathalie Rommel

  3. Gastroenterology Unit, Women's and Children's Health Network, 72 King William Street, 5006, SA, Australia

    Taher I. Omari

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  1. Maartje M. J. Singendonk
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M.M.J.S. researched data for the article, provided substantial contribution to discussion of the content, wrote the article and reviewed/edited the manuscript before submission. N.R. wrote and reviewed/edited the manuscript before submission. T.I.O., M.A.B. and M.P.v.W. provided substantial contributions to discussion of the content and reviewed/edited the manuscript before submission.

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Correspondence to Marc A. Benninga.

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Singendonk, M., Rommel, N., Omari, T. et al. Upper gastrointestinal motility: prenatal development and problems in infancy. Nat Rev Gastroenterol Hepatol 11, 545–555 (2014). https://doi.org/10.1038/nrgastro.2014.75

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