Biomechanics of failed deglutitive upper esophageal sphincter relaxation in neurogenic dysphagia.
Our aims were to examine the etiology and biomechanical properties of the nonrelaxing upper esophageal sphincter (UES) and the relationship between UES opening and failed relaxation. We examined the relationships among swallowed bolus volume, intrabolus pressure, sagittal UES diameter, the pharyngeal swallow response, and geniohyoid shortening in 18 patients with failed UES relaxation, 23 healthy aged controls, and 15 with Zenker's diverticulum. Etiology of failed UES relaxation was 56% medullary disease, 33% Parkinson's or extrapyramidal disease; and 11% idiopathic. Extent of UES opening ranged from absent to normal and correlated with preservation of the pharyngeal swallow response (P = 0.012) and geniohyoid shortening (P = 0.046). Intrabolus pressure was significantly greater compared with aged controls (P < 0.001) or Zenker's diverticulum (P < 0.001). The bolus volume-dependent increase in intrabolus pressure evident in controls was not observed in failed UES relaxation. The nonrelaxing UES therefore displays a constant loss of sphincter compliance throughout the full, and potentially normal, range of expansion during opening. Adequacy of UES opening is influenced by the degree of preservation of the pharyngeal swallow response and hyolaryngeal traction. In contrast, the stenotic UES displays a static loss of compliance, only apparent once the limit of sphincter expansion is reached.
Williams
Rohan B H
RB
Department of Gastroenterology, The St. George Hospital, The University of New South Wales, Sydney, New South Wales, 2217 Australia.
Wallace
Karen L
KL
Ali
Galib N
GN
Cook
Ian J
IJ
D000328:Adult; D000368:Aged; D000403:Airway Resistance; D003680:Deglutition Disorders / Q000209:etiology* / Q000503:physiopathology*; D004943:Esophagogastric Junction / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009126:Muscle Relaxation; D009422:Nervous System Diseases / Q000150:complications*; D011312:Pressure; D011859:Radiography; D012016:Reference Values; D014743:Videotape Recording