Incomplete Upper Esophageal Sphincter Relaxation: Association with Achalasia but Not Other Esophageal Motility Disorders

Abstract

Incomplete upper esophageal sphincter (UES) relaxation is not well understood. We compared clinical and manometric characteristics of patients with normal and abnormal UES relaxation. Consecutive patients (n = 208) underwent manometric evaluation of the lower esophageal sphincter (LES), esophageal body, and UES/pharynx. The patients were divided into those with abnormal UES relaxation (residual pressure > 6.7 mmHg) (n = 21) and normal relaxation (n = 187). Clinical and manometric profiles were compared. Sex, age, and presenting complaint did not correlate with UES relaxation. Normal esophageal peristaltic sequences were more frequently present in the normal UES group (73.6%) compared with the abnormal (55.8%) (p < 0.01). The UES relaxation was shorter in the group with abnormal relaxation (410.0 ms vs. 510.2 ms, p < 0.001). All other manometric parameters were not different between the two groups. When individual manometric diagnoses were analyzed, only achalasia was noted to be more common in the abnormal UES group (23.8% vs. 9.1%, p < 0.05), and a trend was noted toward diffuse esophageal spasm being more common (14.3% vs. 9.6%, not significant). We conclude that incomplete UES relaxation is a rare manometric finding, associated with achalasia and not specifically associated with any other motility disturbance. This finding may represent a secondary response to the poor esophageal emptying seen in achalasia.

Upper esophageal sphincter (UES) metrics on high‐resolution manometry (HRM) differentiate achalasia subtypes

“…2,14,16 This reduces esophageal pressurization, and we speculate that this The elevation of UES residual pressures in achalasia compared to healthy controls has been demonstrated previously. [3][4][5][6][7] The fact that UES-RP but not UES basal pressure is elevated suggests that this is a reflexive response to esophageal pressurization rather than an involuntary pressure artifact 17 -this is well demonstrated with esophageal pressurization from infused water to simulate refluxed volume within the esophageal body. As a cross-sectional analysis of patients who underwent HRM for any indication, this study was not designed to investigate disease pathophysiology or clinical outcomes.…”

“…Nonetheless, abnormalities of the upper esophageal sphincter (UES), the skeletal muscle barrier between the esophagus and the pharynx, have been consistently reported in achalasia. [3][4][5][6][7][8][9][10] Elevations in both UES basal pressures and postswallow residual pressures have been reported, with improvement of the latter following pneumatic dilation. 6,7 Some suggest that UES motor abnormalities correlate with worse treatment response.…”

Schluckstörungen

“…Der röntgenologisch erkennbare krikopharyngeale Wulst wird in Analogie zu der Achalasie des unteren Ösophagus (früher Kardiospasmus) mit einem Muskelspasmus assoziiert [25,31,102,120], tritt aber auch infolge fibrotischem oder degenerativem Muskelumbau auf [23]. 1 und 3).…”

“…Hinzu kommen zentral bedingte Störungen der Speichelsekretion, zerebrale Durchblutungsstörungen, das Mittelhirnsyndrom und extrapyramidal-motorische Störungen wie M. Parkinson, [5]. Konsekutiv kann eine Relaxationsstörung des oberen Ösophagussphinkters auftreten (sekundäre krikopharyngeale Achalasie) im Sinne einer Multisphinktererkrankung [25,119]. Die Therapie der Wahl ist eine pneumatische Dilatation des unteren Ösophagussphinkters.…”

Análise estrutural da laringofaringe e suas implicações na miotomia do cricofaríngeo, na injeção de toxina botulínica e na dilatação por balão

“…A estrutura considerada como responsável principal por esta zona de alta pressão é o músculo cricofaríngeo. Admite-se que o músculo cricofaríngeo, contraído durante o repouso, relaxa-se quando da deglutição para permitir a passagem do bolo em trânsito da faringe para o esôfago (10,11,13,15,16,17,29,30,33) . O conceito de ser o cricofaríngeo o músculo responsável por esta zona de alta pressão sustenta também o conceito de acalásia do cricofaríngeo (acálasia do EES -esfíncter esofágico superior) (21,28) , que se define como distúrbio de motilidade em que o EES deixa de relaxar-se durante a deglutição, manifestando disfagia intermitente (26,31) .…”