Pharyngeal findings in 21 patients with achalasia of the esophagus

Jones, Bronwyn; Donner, Martin W.; Rubesin, Stephen E.; Ravich, William J.; Hendrix, Thomas R.

doi:10.1007/bf02408139

Cited by 44 publications

(20 citation statements)

References 24 publications

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“…Radiologic examination of the pharynx revealed cricopharyngeal prominence, asymmetry of pharyngeal contraction or epiglottic tilt, and lateral pharyngeal pouches [22]. A study using manometry revealed increased residual UES pressure and reduction of UES relaxation duration with a rapid onset of pharyngeal contraction after UES relaxation [23].…”

Section: Discussionmentioning

confidence: 99%

Videofluoroscopic Evaluation of Swallowing in Chagas’ Disease

2011

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Dysphagia is the most common digestive symptom reported by patients with Chagas' disease. The condition results from abnormalities of esophageal motility. Our hypothesis is that there are also alterations of oral and pharyngeal transit during swallowing. We studied by videofluoroscopy the oral and pharyngeal transit during swallowing in 17 patients with dysphagia, a positive serologic test for Chagas' disease, and radiologic demonstration of esophageal involvement. The study also included 15 asymptomatic healthy volunteers. Each subject swallowed in duplicate 5 and 10 ml of liquid and paste barium boluses. Chagas' disease patients had a longer oropharyngeal transit with the 5-ml liquid bolus (p = 0.03), and a longer oral transit (p = 0.01) and pharyngeal transit (p = 0.04) with the 10-ml liquid bolus than controls. There was no difference between patients and controls with swallows of the 5-ml paste bolus. With swallows of the 10-ml paste bolus, the oropharyngeal transit (p = 0.05), pharyngeal transit (p = 0.04), pharyngeal clearance (p = 0.02), and UES opening (p = 0.01) took a longer amount of time in Chagas' disease patients than in controls. We conclude that the duration of pharyngeal transit is longer in patients with Chagas' disease than in normal subjects, especially with a bolus of pasty consistency and a volume of 10 ml.

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Section: Discussionmentioning

confidence: 99%

Videofluoroscopic Evaluation of Swallowing in Chagas’ Disease

2011

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“…Swallowing depends on fine coordination between UES relaxation and pharyngeal contractions, which forces food through the sphincter into the esophagus. A number of abnormalities in UES function have also been described in achalasia, including: (a) elevated UES residual pressure (11,12), that is, the difference between the pressure recorded at the nadir of UES relaxation and baseline pressure, (b) decreased duration of UES relaxation (13,14), (c) repetitive UES contractions (15), and (d) a loss of belch reflex with normal deglutitive UES relaxation (16,17). The present patient had experienced difficulty in belching for a long time and her symptoms were consistent with failure of the belch reflex caused by insufficient UES relaxation, which led to progressive esophageal distension.…”

Section: Discussionmentioning

confidence: 99%

Acute Airway Obstruction in a Patient with Achalasia

et al. 2011

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Megaesophagus resulting from achalasia is a rare but serious cause of acute airway obstruction. We treated achalasia in a 52-year-old woman with acute respiratory distress and stridor. Chest X-ray and endoscopy showed a marked dilatation of the cervical esophagus with a large amount of undigested food. Emergency suction of the food through a nasogastric tube led to decompression of the esophagus and the immediate relief of respiratory symptoms. These findings suggest a dysfunction of the upper esophageal sphincter as a possible mechanism. As this exceptional complication of achalasia is fatal, a wider appreciation is required.

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“…Reports in the literature indicate that esophageal dysmotility and pharyngeal dysphagia are common co-occurrences [75][76][77], suggesting that the two have a common pathophysiology.…”

Section: Variables Significantly Associated With Aspiration Pneumoniamentioning

confidence: 99%

Predictors of Aspiration Pneumonia: How Important Is Dysphagia?

et al. 1998

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Aspiration pneumonia is a major cause of morbidity and mortality among the elderly who are hospitalized or in nursing homes. Multiple risk factors for pneumonia have been identified, but no study has effectively compared the relative risk of factors in several different categories, including dysphagia. In this prospective outcomes study, 189 elderly subjects were recruited from the outpatient clinics, inpatient acute care wards, and the nursing home care center at the VA Medical Center in Ann Arbor, Michigan. They were given a variety of assessments to determine oropharyngeal and esophageal swallowing and feeding status, functional status, medical status, and oral/dental status. The subjects were followed for up to 4 years for an outcome of verified aspiration pneumonia. Bivariate analyses identified several factors as significantly associated with pneumonia. Logistic regression analyses then identified the significant predictors of aspiration pneumonia. The best predictors, in one or more groups of subjects, were dependent for feeding, dependent for oral care, number of decayed teeth, tube feeding, more than one medical diagnosis, number of medications, and smoking. The role that each of the significant predictors might play was described in relation to the pathogenesis of aspiration pneumonia. Dysphagia was concluded to be an important risk for aspiration pneumonia, but generally not sufficient to cause pneumonia unless other risk factors are present as well. A dependency upon others for feeding emerged as the dominant risk factor, with an odds ratio of 19.98 in a logistic regression model that excluded tube-fed patients.

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Pharyngeal findings in 21 patients with achalasia of the esophagus

Cited by 44 publications

References 24 publications

Videofluoroscopic Evaluation of Swallowing in Chagas’ Disease

Videofluoroscopic Evaluation of Swallowing in Chagas’ Disease

Acute Airway Obstruction in a Patient with Achalasia

Predictors of Aspiration Pneumonia: How Important Is Dysphagia?

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