The pathology of a cricopharyngeal dysphagia

Abstract

The paper describes the changes in the cricopharyngeal muscle in seven cases of dysphagia resulting from obstruction at this level which was relieved by myotomy. Histological features included degeneration and regeneration in the muscle fibres with interstitial fibrosis which was severe in some of the cases. It is considered that this restrictive fibrosis is the cause of the dysphagia and that it is secondary to muscle fibre damage, the cause of which is at present obscure. Minor degrees of muscle damage and regeneration were seen rarely in controls and fibrosis was never present. There was no evidence of underlying vascular or neurological disease in six cases; the seventh had a previous history of scleroderma but this was not thought to be the cause of the cricopharyngeal lesion. The age incidence ranged from 1 to 5 years at the onset of dysphagia; in six of the seven it was 50 years or more.

Facioscapulohumeral Muscular Dystrophy: A Radiologic and Manometric Study of the Pharynx and Esophagus

“…We believed that the upper alimentary tract dysmotility was reflux-induced [25] and unrelated to the muscle disease of FSHD. Published reports on biopsy specimens of the cricopharyngeal muscle in patients with gastroesophageal reflux-induced oropharyngeal dysphagia showed mild-to-severe fibrosis and ultrastructural abnormalities on electron microscopy, such as numerous and aberrant mitochondria, increased glycogen, lipid inclusions, phagolyzosomes, and nemaline rods [26,27]. It has been postulated that these pathologic changes are a secondary response to reflux-induced injury.…”

Esophagus: anatomy and developmental and structural anomalies

“…Symptomatic CP bars most commonly present in the elderly with dysphagia for solids and occasionally liquids as well. Studies have also shown histological changes similar to those found in patients with Zenker diverticulum that include muscle degeneration and fibrosis [169]. It is important to exclude other more common etiologies for dysphagia since a CP bar may be an incidental finding.…”

Cricopharyngeal Muscle Hypertrophy Associated with Florid Myositis

“…The systemic diseases reported so far include dermatomyositis [12], polymyositis [13,14], inclusion body myositis [15±18], generalized granulomatous disease [11], and neuromuscular degeneration [3]. Concomitant scleroderma was observed in one case, but there were no histological signs of scleroderma in the cricopharyngeal muscle biopsy [9]. Recently, it was shown that dysphagia occurred in 807 of patients with inclusion body myositis [19].…”