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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Clinical manifestations and surgical results are analyzed in a retrospective study of 16 patients with a Zenker's diverticulum. Pharyngoesophageal diverticulum are an uncommon anomaly, producing cervical dysphagia and recurrent airway infections. Treatment should be surgical, as earliest as possible. Morbidity is very low and mortality very rare.
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PMID:[Zenker's diverticulum. The clinical manifestations and treatment]. 161 38

Twenty patients with a remote history of poliomyelitis and recent or progressive dysphagia were evaluated with cinefluorography. Radiographic abnormalities were present in the pharynx in varying degrees in all but one of the patients. Findings included atrophy of the prevertebral soft tissues, unilateral or bilateral weakness of the tongue or soft palate, paresis or paralysis of the pharyngeal constrictor muscle, incomplete or absent epiglottic tilt, poor laryngeal elevation, poor laryngeal closure with laryngeal penetration, aspiration (often without a cough), and luminal narrowing at the cricopharyngeal level. Other structural lesions included a Zenker diverticulum in one patient, bilateral pharyngeal pouches in five, and a unilateral pouch in one. Additional structural lesions contributing to dysphagia were found in two other patients, including a focal stricture in the cervical esophagus in one patient and two stenotic rings in the distal esophagus in another. In four patients (one of whom had the Zenker diverticulum), the inferior constrictor muscle contracted forcibly above a prominent cricopharyngeus muscle, perhaps contributing to the formation of the diverticulum. It is important to examine postpolio patients with dysphagia carefully with dynamic imaging to assess the severity of decompensation and to detect other lesions that may be treatable. The information derived can be used to guide management.
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PMID:Swallowing dysfunction in the postpolio syndrome: a cinefluorographic study. 172 82

Symptoms of high dysphagia are sometimes too readily interpreted as symptoms of globus. When patients have unmistakable difficulties during meals, focused diagnostic procedures are indicated. The upper esophageal sphincter (UES) is the key structure at the transition from hypopharynx to esophagus. In many disorders presenting with dysphagia, the UES mechanism remains intact and can cause the symptoms. Especially in patients with a hypopharyngeal (Zenker's) diverticulum and in patients with a hypopharyngeal paralysis due to a neurologic disorder, sphincterotomy may be indicated. In the microendoscopic treatment of Zenker's diverticulum, a transmucosal sphincterotomy is created and at the same time a more ample overflow from diverticulum to esophagus is effected. In view of our results in 507 patients we are justified in maintaining that this procedure can be regarded as a safe and effective treatment. In patients with neurologic dysphagia, sphincterotomy by an external approach can ensure adequate passage of food from the hypopharynx to the esophagus, resulting in marked improvement of the dysphagic symptoms. Our technique and results of external approach sphincterotomy are described here.
Dysphagia 1991
PMID:Upper esophageal sphincterotomy in dysphagic patients with and without a diverticulum. 177 2

The classic symptoms of dysphagia, heartburn, and chest pain are the presenting manifestation of oropharyngeal and esophageal disorders in the elderly as well as the young. Several unique conditions, including Zenker's diverticulum and vascular compression of the esophagus, may occur in the elderly. Certain disorders, such as oropharyngeal dysphagia due to neurologic disorder, increase in frequency with age. Treatment approaches are similar in elderly and younger patients, but the potential for adverse drug effects and interaction is greater in the elderly than in the young.
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PMID:Swallowing disorders in the elderly. 185 55

Prolonged cricopharyngeal dysfunction due to various causes can lead to severe dysphagia, aspiration, pneumonia, debilitation and subsequent pharyngoesophageal (Zenker's) diverticulum. This paper reports the successful use of cricopharyngeal myotomy with diverticulopexy for management of huge Zenker's diverticulum on five high-risk patients. The advantages of this method are immediate swallowing, short hospitalization, and avoidance of serious complication.
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PMID:Cricopharyngeal myotomy with diverticulopexy for Zenker's diverticulum. 190 Sep 75

Surgery for the treatment of Zenker's diverticulum was performed at our institution in a total of 43 patients over 6 1/2 years. Cervical myotomy with diverticulectomy was performed in 32 of the patients and myotomy alone in 11. Mortality totaled 0%, with a reversible lesion of the recurrent nerve occurring in 7%. In 60% of the cases investigated preoperatively (N = 40), motility disorders of the upper esophageal sphincter (UES) could be demonstrated using manometry as well as with cineradiography in 92% of the patients. Follow-up studies in 39 of the cases 25 months (mean) postprocedure indicated 82% of the patients to be symptom-free, with the remaining 18% demonstrating a marked improvement. Postoperative manometry as well as cineradiography carried out in 12 patients revealed the presence of UES motility dyscoordination in 8% and 25%, respectively. There were, however, no signs of recurrence of the diverticulum. The high number of patients in our study group demonstrating motility disorders of the UES emphasizes the need for cervical myotomy as part of the surgical therapy for Zenker's diverticulum.
Dysphagia 1990
PMID:Surgical therapy of Zenker's diverticulum: low risk and high efficiency. 211 24

Cricopharyngeal myotomy was performed on 60 patients suffering from cervical oesophageal dysphagia. Of 37 that had a Zenker diverticulum the diverticulum was excised in 24. All patients were free of symptoms on post-operative follow-up at 2-10 years. In 10 patients with a cervical oesophageal web or postcricoid stenosis, the ability to eat normal food was restored. In 7 of 9 patients with neuromuscular diseases affecting swallowing and 2 of 4 patients with cricopharyngeal achalasia, food intake improved after myotomy. Apart from 4 transient palsies of the left recurrent nerve and 2 patients with aspiration pneumonia, no serious complications occurred. Cricopharyngeal myotomy can be a safe and effective method to improve the swallowing and quality of life of patients suffering from cervical oesophageal dysphagia of varied aetiology.
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PMID:Cricopharyngeal myotomy in the treatment of dysphagia. 211 33

Although diverticulopexy for the treatment of Zenker's diverticulum was described more than 75 years ago, its use has been infrequently reported in the surgical literature. Between 1974 and 1987, thirty-two patients manifested dysphagia caused by a pharyngoesophageal diverticulum. Twelve patients underwent diverticulopexy with cricopharyngeal myotomy, whereas the others had a one-stage resection of the diverticulum with myotomy. Complications of diverticulectomy were rare, but included an instance of esophageal leak, which responded to conservative therapy. Despite this low complication rate, diverticulopexy with myotomy was used in patients who possessed risk factors that made them unsuitable candidates for diverticulectomy. These factors included a debilitated state from effects of the diverticulum, a history of postsurgical complications, multiple medical illnesses, advanced age with inability to ambulate, and insulin-dependent diabetes mellitus. A nasogastric tube was not necessary after diverticulopexy. This allowed oral intake on the first postoperative day, immediate ambulation, and a shorter hospital stay. Objective recurrence occurred in one patient who underwent diverticulopexy and myotomy caused by manipulation of the sac during a subsequent surgical procedure, but significant dysphagia did not occur. Thus, although diverticulectomy has proved to be a relatively safe procedure, diverticulopexy with cricopharyngeal myotomy is recommended for high-risk patients in whom potential complications from diverticulum excision and prolonged hospitalization could be devastating.
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PMID:Diverticulopexy and cricopharyngeal myotomy: treatment for the high-risk patient with a pharyngoesophageal (Zenker's) diverticulum. 249 11

Hypopharyngeal diverticula are relatively unknown, with the exception of Zenker's diverticulum. Spot-camera and videorecording techniques were employed for the examination of 95 dysphagic and 250 asymptomatic patients. On the whole, 345 cases. 40% of diverticula were found in dysphagic patients, and 14% in asymptomatic ones. Fifty diverticula were detected through the thyrohyoid membrane, and 14 pseudodiverticula, 4 Zenker's diverticula, 4 lateral diverticula at the pharyngoesophageal junction, and 2 outpouchings through the tonsillar fossa. A statistically significant correlation (p less than 0.001) with dysphagia was demonstrated only for diverticula through the thyrohyoid membrane. Most pathologic findings were associated with other swallowing dysfunctions.
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PMID:[Diverticula of the pharyngoesophageal area]. 249 62

We reviewed 12 patients who underwent diverticulectomy and myotomy for Zenker's diverticulum. Fifty percent of these patients were found to have cervical esophageal webs that were resected at operation. The association of Zenker's diverticulum and esophageal webs is new. The present study demonstrates that it is not a rare relationship and that these webs can cause postoperative problems. We utilized the technique of open diverticulectomy and found that it facilitates cricopharyngeal myotomy and allowed intraoperative inspection of the esophageal lumen, thereby patients with coexisting intraesophageal pathologic abnormalities could be identified. This procedure can be performed within very acceptable limits of morbidity, as demonstrated in our study, although it is not recommended for surgeons who do not regularly operate on the esophagus. Surgeons should consider this technical approach to Zenker's diverticulum when the presence of cervical webs is known or suspected preoperatively. Cervical esophageal webs are a potential source of postoperative dysphagia. They should therefore be excised when encountered intraoperatively. The actual incidence of cervical esophageal webs and their potential role in the pathogenesis of cricopharyngeal muscle hypertrophy and Zenker's diverticulum will require additional study.
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PMID:Cervical esophageal web associated with Zenker's diverticulum. 313 26


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