Document Detail

Dilatation therapy for dysphagia in patients with upper esophageal sphincter dysfunction--manometric and symptomatic response.
MedLine Citation:
PMID:  10071809     Owner:  NLM     Status:  MEDLINE    
Inability to maintain oral nutrition due to oropharyngeal dysphagia is common in patients with a variety of neurological and neuromuscular disorders and severely affects quality of life. Cricopharyngeal dilatation has been used as empiric therapy in these patients, but little data exist on symptom response and there is no data on the effect on the manometric characteristics of the upper esophageal sphincter (UES) and pharynx. We studied 10 patients with oropharyngeal dysphagia and either elevated upper esophageal sphincter resting pressure, or a high residual pressure or attenuated duration of relaxation on swallowing. Dilatation therapy was performed with an 18-20 mm Savary dilator and manometry was repeated after an average period of 4 weeks. Nine out of 10 patients had improvement in dysphagia and have maintained oral nutrition for a mean follow-up of 13 months. UES residual pressure decreased in nine out of 10 patients and the group median value decreased significantly from 10.8 mmHg pretreatment to 5.7 mmHg after therapy (P < 0.05). UES resting pressure decreased in eight out of 10 patients and the group median value decreased from 82 to 43 mmHg (P < 0.05). Duration of relaxation did not change significantly. Videoradiography was normal in five out of nine responders to therapy. For selected patients with oropharyngeal dysphagia and manometric signs of UES dysfunction, dilatation therapy may give excellent symptomatic relief, apparently by reducing UES resting pressure and/or increasing the duration and completeness of relaxation.
J G Hatlebakk; J A Castell; J Spiegel; V Paoletti; P O Katz; D O Castell
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus / I.S.D.E     Volume:  11     ISSN:  1120-8694     ISO Abbreviation:  Dis. Esophagus     Publication Date:  1998 Oct 
Date Detail:
Created Date:  1999-04-20     Completed Date:  1999-04-20     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  8809160     Medline TA:  Dis Esophagus     Country:  SCOTLAND    
Other Details:
Languages:  eng     Pagination:  254-9     Citation Subset:  IM    
Department of Medicine, Allegheny University Hospitals, Graduate, Philadelphia, Pennsylvania, USA.
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MeSH Terms
Deglutition Disorders / etiology*,  physiopathology,  radiography,  therapy
Esophageal Diseases / complications,  physiopathology,  therapy*
Esophagus* / physiopathology
Middle Aged
Oropharynx / physiopathology
Pharynx / physiopathology
Grant Support

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