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.

The Cricopharyngeus in the Neonate

1980 ◽  
Vol 89 (5) ◽  
pp. 446-449 ◽  
Author(s):  
Timothy J. Reichert ◽  
Kenneth D. Faw
Keyword(s):  
Upper Esophageal Sphincter ◽  
Airway Protection ◽  
Sphincter Function ◽  
Cricopharyngeus Muscle ◽  
Total Length ◽  
Esophageal Sphincter ◽  
Neonates And Infants

The cricopharyngeus muscle in neonates and infants has not been well established. It is found, like other laryngopharyngeal structures in infants, to be relatively much larger than its counterpart in the adult but not large enough to correlate with the total length of reported sphincter function. It also varies significantly in size, and therefore probably does not contribute completely to the function of the upper esophageal sphincter. Its relationship to airway protection, regurgitation and respiration needs to be more thoroughly studied.

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.

Morphology of the Upper Esophageal Sphincter or Cricopharyngeus Muscle Revisited

2019 ◽  
Vol 33 (5) ◽  
pp. 782-794 ◽  
Author(s):  
Masahito Yamamoto ◽  
Keishi Hashimoto ◽  
Yohei Honkura ◽  
Gen Murakami ◽  
Hiroshi Abe ◽  
...  
Keyword(s):  
Upper Esophageal Sphincter ◽  
Cricopharyngeus Muscle ◽  
Esophageal Sphincter

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

Disorders Involving the Pharynx and Upper Esophagus

2016 ◽  
Author(s):  
Hiroshi Mashimo
Keyword(s):  
Viral Infections ◽  
Oropharyngeal Dysphagia ◽  
Neuromuscular Control ◽  
Upper Esophageal Sphincter ◽  
Peritonsillar Abscess ◽  
Zenker’S Diverticulum ◽  
Zenker's Diverticulum ◽  
Globus Pharyngeus ◽  
Submental Muscles ◽  
Esophageal Sphincter

A wide variety of disorders can affect the pharynx and upper esophagus, such as inherited or acquired structural abnormalities, malignancies, and inflammation secondary to a number of etiologies including bacterial, yeast and viral infections, irradiation, and gastroesophageal reflux disorder. Laryngoceles and peritonsillar abscess can also lead to pain and dysfunction. However, this review will focus on the main motility disorders that affect the pharynx and upper esophagus, namely oropharyngeal dysphagia, disorders associated with globus pharyngeus, and Zenker’s diverticulum. Figures show the anatomy of the three stages of normal swallow, various findings on functional endoscopic evaluation of swallowing, electromyography of the cricopharyngeal sphincter and submental muscles, and Zenker’s diverticulum. Tables list causes of oropharyngeal dysphagia, neuromuscular control of the pharyngeal phase (with identified cranial and cervical spinal nerve roots), pathophysiology of oropharyngeal dysplasia, diagnostic tests for oropharyngeal dysplasia, behavioral treatments to improve swallow and reduce aspiration, and potential overlapping causes of impaired upper esophageal sphincter relaxation.   This review contains 4 highly rendered figures, 6 tables, and 40 references   Key words: Oropharyngeal dysphagia; Globus; Upper esophageal sphincter dysfunction; Swallowing disorder; Dysphagia; Zenker’s diverticulum; Swallow assessment; Globus pharyngeus

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