Diagnosis of Upper Esophageal Sphincter Disorder: A Study in Healthy Volunteers and Patients With Oropharyngeal Dysphagia

2021 ◽  
Author(s):  
Taher Omari ◽  
Charles Cock ◽  
Peter Wu ◽  
Michal Szczesniak ◽  
Mistyka Schar ◽  
...  
Keyword(s):  
Healthy Volunteers ◽  
Oropharyngeal Dysphagia ◽  
Upper Esophageal Sphincter ◽  
Esophageal Sphincter

scholarly journals Upper Esophageal Sphincter Dilation for Recalcitrant Dysphagia Secondary to Dermatomyositis

2019 ◽  
Vol 98 (9) ◽  
pp. NP142-NP143
Author(s):  
Mallory J. Raymond ◽  
Nancy L. McColloch ◽  
Jeanne L. Hatcher
Keyword(s):  
Medical Management ◽  
Oropharyngeal Dysphagia ◽  
Autoimmune Disorder ◽  
Upper Esophageal Sphincter ◽  
Esophageal Dysmotility ◽  
Cricopharyngeus Muscle ◽  
Transnasal Esophagoscopy ◽  
Esophageal Sphincter

Dermatomyositis is a rare multisystem autoimmune disorder occasionally accompanied by dysphagia. It is typically treated with immune modulating agents; however, dysphagia is often unresponsive to these. Previous reports have demonstrated the utility of videoflouroscopy and manometry in understanding the etiologies of dysphagia to inform a procedural target, historically the cricopharyngeus muscle. We present a case of dermatomyositis and dysphagia resistant to medical management in a patient found by videoflouroscopy and manometry to have severe oropharyngeal dysphagia, esophageal dysmotility and a cricopharyngeal web. We demonstrate the utility and safety of upper esophageal sphincter dilation by transnasal esophagoscopy even in the setting of multifactorial dysphagia.

scholarly journals A human model of restricted upper esophageal sphincter opening and its pharyngeal and UES deglutitive pressure phenomena

2016 ◽  
Vol 311 (1) ◽  
pp. G84-G90 ◽  
Author(s):  
Hongmei Jiao ◽  
Ling Mei ◽  
Tarun Sharma ◽  
Mark Kern ◽  
Patrick Sanvanson ◽  
...  
Keyword(s):  
Contractile Function ◽  
Cricoid Pressure ◽  
Cricoid Cartilage ◽  
Oropharyngeal Dysphagia ◽  
Upper Esophageal Sphincter ◽  
The Other ◽  
Human Model ◽  
Esophageal Sphincter ◽  
Ues Opening ◽  
High Pressure Zone

Oropharyngeal dysphagia due to upper esophageal sphincter (UES) dysfunction is commonly encountered in the clinical setting. Selective experimental perturbation of various components of the deglutitive apparatus can provide an opportunity to improve our understanding of the swallowing physiology and pathophysiology. The aim is to characterize the pharyngeal and UES deglutitive pressure phenomena in an experimentally induced restriction of UES opening in humans. We studied 14 volunteers without any dysphagic symptoms (7 men, 66 ± 11 yr) but with various supraesophageal reflux symptoms. To induce UES restriction, we used a handmade device that with adjustment could selectively apply 0, 20, 30, or 40 mmHg pressure perpendicularly to the cricoid cartilage. Deglutitive pharyngeal and UES pressure phenomena were determined during dry and 5- and 10-ml water swallows × 3 for each of the UES perturbations. External cricoid pressure against the UES resulted in a significant increase in hypopharyngeal intrabolus pressure and UES nadir deglutitive relaxation pressure for all tested swallowed volumes ( P < 0.05). Application of external cricoid pressure increased the length of the UES high pressure zone from 2.5 ± 0.2 to 3.1 ± 0.2, 3.5 ± 0.1, and 3.7 ± 0.1 cm for 20, 30, and 40 mmHg cricoid pressure, respectively ( P < 0.05). External cricoid pressure had no significant effect on pharyngeal peristalsis. On the other hand, irrespective of external cricoid pressure deglutitive velopharyngeal contractile integral progressively increased with increased swallowed volumes ( P < 0.05). In conclusion, acute experimental restriction of UES opening by external cricoid pressure manifests the pressure characteristics of increased resistance to UES transsphincteric flow observed clinically without affecting the pharyngeal peristaltic contractile function.

scholarly journals Injection of Botulinum Toxin a to Upper Esophageal Sphincter for Oropharyngeal Dysphagia in Two Patients with Inclusion Body Myositis

2004 ◽  
Vol 18 (6) ◽  
pp. 397-399 ◽  
Author(s):  
Louis WC Liu ◽  
Mark Tarnopolsky ◽  
David Armstrong
Keyword(s):  
Botulinum Toxin ◽  
Inclusion Body ◽  
Inclusion Body Myositis ◽  
Botulinum Toxin A ◽  
Oropharyngeal Dysphagia ◽  
Upper Esophageal Sphincter ◽  
Muscle Disease ◽  
Sphincter Pressure ◽  
Toxin A ◽  
Esophageal Sphincter

Inclusion body myositis (IBM) is a progressive degenerative skeletal muscle disease leading to weakening and atrophy of both proximal and distal muscles. Dysphagia is reported in up to 86% of IBM patients. Surgical cricopharyngeal myotomy may be effective for cricopharyngeal dysphagia and there is one published report that botulinum toxin A, injected into the cricopharyngeus muscle using a hypopharyngoscope under general anesthesia, relieved IBM-associated dysphagia. This report presents the first documentation of botulinum toxin A injection into the upper esophageal sphincter using a flexible esophagogastroduodenoscope under conscious sedation, to reduce upper esophageal sphincter pressure and successfully alleviate oropharyngeal dysphagia in two IBM patients.

Swallowing and upper esophageal sphincter contraction with transcranial magnetic-induced electrical stimulation

1993 ◽  
Vol 264 (2) ◽  
pp. G213-G219 ◽  
Author(s):  
D. T. Valdez ◽  
A. Salapatek ◽  
G. Niznik ◽  
R. D. Linden ◽  
N. E. Diamant
Keyword(s):  
Electrical Stimulation ◽  
Stimulus Intensity ◽  
Magnetic Stimulation ◽  
Oropharyngeal Dysphagia ◽  
Sensory Stimulation ◽  
Upper Esophageal Sphincter ◽  
Twitch Contraction ◽  
Magnetic Stimulus ◽  
Esophageal Sphincter ◽  
Stimulation Of

This study in three dogs explores the effect of magnetically induced electrical stimulation of the brain to induce swallowing and produce contraction of the upper esophageal sphincter (UES). Single stimuli were delivered at intervals from 15 s to 3 min. Studies were performed with and without perfusion of fluid into the pharynx and upper esophagus. Results showed that magnetic stimulation produced a twitch contraction of the UES when stimulus intensity was above a threshold that varied between 14 and 20% of the stimulator output. Increasing stimulus intensity progressively increased twitch amplitude. Magnetic stimulation also induced swallowing, above a stimulus threshold similar to that for induction of the UES twitch contraction. Fluid perfusion augmented the ability of the magnetic stimulus to induce swallowing. We concluded that a magnetically induced single electrical stimulus of the cerebral cortex produces UES contraction and induces swallowing. The effect on swallowing is facilitated by sensory stimulation of the pharynx. This technique holds the potential for further study of 1) motor and sensory neural mechanisms involved in the control of swallowing and 2) the assessment and management of oropharyngeal dysphagia in humans.

Cricopharyngeal Dysfunction

1992 ◽  
Vol 106 (2) ◽  
pp. 163-168 ◽  
Author(s):  
Janet A. Wilson ◽  
Anne Pryde ◽  
Paul L. Allan ◽  
Arnold G.D. Maran
Keyword(s):  
Healthy Volunteers ◽  
Upper Esophageal Sphincter ◽  
Control Group ◽  
Muscular Hypertrophy ◽  
Cricopharyngeal Myotomy ◽  
Esophageal Sphincter ◽  
Cricopharyngeal Dysfunction ◽  
Ues Opening ◽  
Dysphagic Patients ◽  
Radiologic Evidence

The aim of the study was to determine the manometric patterns in dysphagic patients with radiologic evidence of upper esophageal sphincter (UES) dysfunction. Nineteen patients with radiographic abnormalities of the UES underwent measurement of several parameters of UES tonic pressure and pharyngoesophageal water swallow dynamics. At least two UES tonic pressures were elevated in six subjects, compared with a control group of 67 healthy volunteers. No patient had UES achalasia. The cricopharyngeal impression in the remaining patients may represent muscular hypertrophy or deficiency of UES opening, despite manometric relaxation, but its relationship to the patient's symptoms remains unknown. Cricopharyngeal myotomy appears to be a reasonable treatment for patients with manometric UES hypertonicity.

Function of upper esophageal sphincter during swallowing: the grabbing effect

1997 ◽  
Vol 272 (5) ◽  
pp. G1057-G1063
Author(s):  
P. Pouderoux ◽  
P. J. Kahrilas
Keyword(s):  
Healthy Volunteers ◽  
Axial Force ◽  
Traction Force ◽  
Force Transducer ◽  
Upper Esophageal Sphincter ◽  
Cervical Esophagus ◽  
Sphere Diameter ◽  
Laryngeal Inlet ◽  
Pharyngeal Swallow ◽  
Esophageal Sphincter

This study investigated deglutitive axial force developed within the pharynx, upper esophageal sphincter (UES), and cervical esophagus. Position and deglutitive excursion of the UES were determined using combined manometry and videofluoroscopy in eight healthy volunteers. Deglutitive clearing force was quantified with a force transducer to which nylon balls of 6- or 8-mm diameter were tethered and positioned within the oropharynx, hypopharynx, UES, and cervical esophagus. Axial force recordings were synchronized with videofluoroscopic imaging. Clearing force was dependent on both sphere diameter (P < 0.05) and location, with greater force exhibited in the hypopharynx and UES compared with the oropharynx and esophagus (P < 0.05). Within the UES, the onset of traction force coincided with passage of the pharyngeal clearing wave but persisted well beyond this. On videofluoroscopy, the persistent force was associated with the aboral motion of the ball caught within the UES. Force abated with gradual slippage of the UES around the ball. The force attributable to the combination of UES contraction and laryngeal descent was named the grabbing effect. The grabbing effect functions to transfer luminal contents distal to the laryngeal inlet at the end of the pharyngeal swallow, presumably acting to prevent regurgitation and/or aspiration of swallowed material.

scholarly journals Long-Term Results of External Upper Esophageal Sphincter Myotomy for Oropharyngeal Dysphagia

Dysphagia ◽  
2009 ◽  
Vol 25 (3) ◽  
pp. 169-176 ◽  
Author(s):  
Martijn P. Kos ◽  
Eric F. David ◽  
Elly C. Klinkenberg-Knol ◽  
Hans F. Mahieu
Keyword(s):  
Oropharyngeal Dysphagia ◽  
Upper Esophageal Sphincter ◽  
Long Term Results ◽  
Esophageal Sphincter

Mechanism and timing of nasopharyngeal closure during swallowing and belching

1995 ◽  
Vol 268 (6) ◽  
pp. G1037-G1042 ◽  
Author(s):  
K. Dua ◽  
R. Shaker ◽  
J. Ren ◽  
R. Arndorfer ◽  
C. Hofmann
Keyword(s):  
Healthy Volunteers ◽  
Soft Palate ◽  
Temporal Relationship ◽  
Upper Esophageal Sphincter ◽  
Pharyngeal Muscle ◽  
Constrictor Muscle ◽  
Complete Closure ◽  
Esophageal Sphincter ◽  
Manometric Technique ◽  
Technique Analysis

The mechanism(s) of nasopharyngeal closure (NPC) and its temporal relationship with other biomechanical events during swallowing and belching were studied in seven healthy volunteers, aged 26-39 yr, by concurrent videoendoscopic, videofluoroscopic, and manometric technique. Analysis of the videoendoscopic recordings showed that deglutitive NPC consisted of elevation of the soft palate and adduction of the superior pharyngeal constrictor muscle. Videofluoroscopy identified only the palatal elevation clearly. During belching, however, only palatal elevation occurred. Deglutitive NPC ranged between 0.73 and 0.94 s (0.8 +/- 0.04 SE), with a tendency to be longer with larger swallowed volumes. Onset of NPC was identified earlier endoscopically than as seen fluoroscopically. Complete NPC preceded the arrival of barium bolus into the pharynx, and this pattern was seen for all volumes tested. Manometric onset of upper esophageal sphincter (UES) relaxation was seen before the onset of NPC, but the physical opening of the UES as seen fluoroscopically occurred after complete closure of the nasopharynx. We conclude the following: 1) The mechanism of NPC during swallowing and belching is different. During swallowing, NPC has two tiers of closure, palatal elevation and superior pharyngeal muscle adduction; during belching only palatal elevation occurs. 2) NPC is tightly coordinated with other biomechanical events during swallowing and belching.

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