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What is the role of the pharyngeal constrictors in pharyngo-esophageal dysfunction ?
P. Gehanno (Paris)
If swallowing is to proceed harmoniously, there must be the conjunction of a propulsive phenomenon associated with contraction of the pharyngeal constrictors dispatching the alimentary bolus towards the esophagus and the permissive phenomenon of opportune opening of the upper esophageal sphincter, represented by the cricopharyngeus muscle.
From time to time, both structures are affected by the same disease, and here the term «pathology of the pharyngo-esophageal junction» is justified. The prototype is represented by myopathies such as Steiner's disease, where histologic studies show a common and specific involvement of the cricopharyngeus and the constrictors of the pharynx.
At other times, however, the dysfunction involves only one of the two components of this mechanism, either hypopharyngeal propulsion or opening of the upper esophageal sphincter.
For lack or proper clinical investigation and manometric study, and also — it must be admitted — because surgical treatment can only be directed to myotomy of the cricopharyngeus, there is a more or less conscious failure to appreciate the role played by the pharyngeal constrictors.
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