Primary Motility  Disorders of the  Esophagus
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OESO©2015
 
Volume: Primary Motility Disorders of the Esophagus
Chapter: Achalasia of the S.E.S. Oropharyngeal dysphagia
 

What are the clinical features of oropharyngeal dysphagia ?

Ph. Ducrotte (Rouen)

Dysphagia is almost constant in upper esophageal sphincter achalasia [1,2]. It may appear suddenly ; more often, it is perceived gradually by the patient who describes that he is often unable to initiate the act of swallowing and repeatedly has to attempt to swallow. The patient is aware that the bolus has not left the oropharynx. Dysphagia is often more pronounced for solids than liquids but sometimes solid food paradoxically is easier to swallow than liquids. Dysphagia which is rarely painful, is associated with the sensation of a lump in the throat. If repeated swallowing, throwing the head back, or down can cause relief. When dysphagia

increases, a liquid bolus may enter the trachea or the nose rather than the esophagus. In severe cases, this is true for saliva as well ingested material, and the patient must drool constantly.

Choking occurring immediately upon the act of swallowing signals deposition of swallowed material into the larynx. Hoarseness and cough become frequent and the patient is often treated for pulmonary infections. In some severe cases, difficulties of swallowing are so important that food ingestion is extremely limited and lead to severe malnutrition.

Other signs may be present but depend of the origin of the achalasia. Symptoms of gastro-esophageal reflux disease (GERD), heartburn, acid regurgitations usually at night or when bending over, are possible. A relationship between the existence of a GERD and oropharyngeal dysphagia has been demonstrated. Sometimes, the sensation of lump in the throat can even be the main symptom leading the patient to seek medical care when heartburn is rare or even absent despite abnormal esophageal pH measurement. However, the frequence of these symptoms of GERD with oropharyngeal dysphagia appears extremely variable from one study to another: 50 p. cent for Henderson [3], 36 p. cent for Hunt [4] but only 9 p. cent for DeMeester [5].

Lastly, globus hystericus, the sensation of a constant pressure, fullness or something stucking in the neck, often increased by stress, has been related to UES achalasia since elevated UES pressures has been found in patients with globus sensation [6]. This point is controversial and recent studies, with modern methodology [7] have demonstrated normal UES pressures and normal UES relaxation in patients with history of globus sensation [8].

References

1. Palmer ED (1976) Disorders of the cricopharyngeus muscle: a review Gastroenterology 71 : 510-519.

2. Hellemans J, Agg HO, Pelemans W, Vantrappen G (1981) Pharyngoesophageal swallowing disorders and the pharyngoesophageal sphincter. Med Clin North Am 65 : 1149-1171.

3. Henderson RD, Woolf C, Marryatt G (1976) Pharyngoesophageal dysphagia and gastroesophageal reflux. Laryngoscope 10: 1531-1539.

4. Hunt PS, Connell AM, Smiley TB (1970) The cricopharyngeal sphincter in gastric reflux. Gut 11 : 303-306.

5. DeMeester T (1988) What are the relations between gastroesophageal reflux and pharyngoesophageal dysphagia ? In : Benign lesions of the esophagus and cancer. Answers to 210 questions. R. Giuli, R.W. McCallum Eds. Springer-Verlag. Berlin-Heidelberg p. 143-144.

6. Watson WC, Sullivan JN (1974) Hypertonicity of cricopharyngeal sphincter: cause of globus sensation. Lancet 2 : 1417-1418.

7. Welch RW, Luckmann K, Ricks PM, Drake ST (1979) Manometry of the normal esophageal sphincter and its alterations in laryngectomy. J Clin Invest 63 : 1036-1041.

8. Cook IJ, Dent J, Collins SM (1989) Upper esophageal sphincter tone and reactivity to stress in patients with history of globus sensation. Dig Dis Sci 34 : 672-676.


Publication date: May 1991 OESO©2015