Yutma Mekanizması Ve Fizyolojik Gastroözofageal Reflü
Özet
Yutma eylemi, gıdaların ağız boşluğundan farinks ve özofagus yoluyla mideye iletilmesini sağlayan, aynı zamanda solunum sistemini koruyan karmaşık ve hayati bir motor reflekstir. Bu süreç oral, faringeal ve özofageal olmak üzere üç istemsiz ve istemli fazdan oluşur. Ağız boşluğunda dudak, dil, diş ve kaslar aracılığıyla bolus haline getirilen gıdalar, yutma merkezinin ve kraniyal sinirlerin koordinasyonuyla farinkse aktarılır. Faringeal evrede solunum anlık olarak durur, epiglottis hava yolunu kapatır ve gıda üst özofagus sfinkterinden geçerek yemek borusuna iletilir. Özofageal evrede ise peristaltik hareketlerle ilerleyen bolus, alt özofagus sfinkterinin gevşemesiyle mideye ulaşır. Reflüyü önleyen alt özofagus sfinkteri, normal şartlarda tonik olarak kasılıdır. Ancak yutma esnasında meydana gelen geçici gevşemeler, büyük öğünler, gaz birikimi, progesteron artışı, sigara, alkol, kafein ile yağlı gıdalar sfinkter basıncını azaltarak asidik mide içeriğinin geri kaçmasına, yani fizyolojik gastroözofageal reflüye neden olur.
Swallowing is a complex and vital motor reflex that delivers food from the oral cavity to the stomach via the pharynx and esophagus while simultaneously protecting the respiratory system. This process consists of three distinct phases: oral, pharyngeal, and esophageal, involving both voluntary and involuntary actions. Food is formed into a bolus within the oral cavity through the synchronized actions of the lips, tongue, teeth, and muscles, and is then transferred to the pharynx under the coordination of the swallowing center and cranial nerves. During the pharyngeal phase, respiration momentarily ceases, the epiglottis seals the airway, and the bolus passes through the upper esophageal sphincter into the esophagus. In the esophageal phase, the bolus is propelled downward by peristaltic waves and enters the stomach as the lower esophageal sphincter relaxes. The lower esophageal sphincter, which prevents reflux, remains tonically contracted under normal conditions. However, transient sphincter relaxations triggered during swallowing, large meals, gas accumulation, increased progesterone levels, smoking, alcohol, caffeine, and fatty foods decrease sphincter pressure, leading to the retrograde flow of acidic gastric content, known as physiological gastroesophageal reflux.
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