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

A case is reported of an elderly woman, a resident in a nursing home, who developed dysphagia over a short period. Clinical and radiological examination disclosed that she had a large laryngocele and a moderate sized consideration of her social circumstances, and careful ranking of the medical priorities. Both the laryngocele and the Zenker's diverticulum were excised at a single operation and she was successfully returned to her nursing home environment.
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PMID:Dysphagia due to simultaneous laryngocele and Zenker's diverticulum. 391 19

Eighteen patients were evaluated for primary symptoms of cervical dysphagia and/or laryngeal aspiration and subsequently had a cricopharyngeal myotomy. Twelve patients had a neurologic lesion as the cause of the symptoms. Four patients had a Zenker's diverticulum as demonstrated by barium contrast roentgenograms. Two patients complained of persistent suprasternal dysphagia following one or more antireflux repairs for gastroesophageal reflux disease. Esophageal manometry identified a pharyngoesophageal motor disorder in all but four patients, two of the four with Zenker's diverticulum and the two who had an antireflux procedure. The results show that cricopharyngeal myotomy should be reserved for patients with an identifiable motor disorder confined to the pharyngeal phase of swallowing, ie, failure of the pharyngeal pump or cricopharyngeal incoordination and/or incomplete relaxation. Exceptions to this rule are as follows: Zenker's diverticulum, in which an abnormality may not always be detected but of which the results of surgery demonstrate the effectiveness of this procedure; and pharyngoesophageal complaints associated with reflux, most of which resolve with the restoration of distal esophageal sphincter competence. In those few patients in whom these conditions persist, a cricopharyngeal myotomy may be beneficial. Caution should be used in applying the procedure to individuals who have had multiple antireflux repairs.
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PMID:Pharyngoesophageal dysfunctions. The role of cricopharyngeal myotomy. 392 Oct 4

A 67-year-old man with upper esophageal dysphagia thought to be caused by a large Zenker's diverticulum was found to have esophageal web at the time of diverticulectomy and cricopharyngeal myotomy. The web was divided by sharp dissection. Untreated, this thin web would almost certainly have resulted in dysphagia postoperatively. The authors therefore recommend routine open diverticulectomy for the management of Zenker's diverticulum, to allow inspection of the esophageal lumen for concomitant disease and palpation of the cricopharyngeal muscle at the time of myotomy.
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PMID:Esophageal web associated with Zenker's diverticulum: a possible cause of continuing dysphagia after diverticulectomy. 392 91

Forty adult patients have undergone a 7 to 10 cm cervical esophagomyotomy (from the superior cornu of the thyroid cartilage to behind the clavicle) for cricopharyngeal dysfunction. A Zenker's diverticulum was present in 12 patients (30%) and in five was recurrent. Preoperative symptoms included cervical dysphagia (85%), expectoration of saliva (40%), and intermittent hoarseness (30%). Four patients were being fed through tubes because of total inability to swallow. "Heartburn" was experienced by one half of the patients, but only 12 had acid or food regurgitation. The duration of symptoms ranged from 1 month to 11 years (average 3.9 years). Weight loss had occurred in 15 patients (38%) and ranged from 5.5 to 40.9 kg (average 16 kg). Barium swallows showed no abnormalities in 10 patients. Abnormal findings included a Zenker's diverticulum (12), prominent cricopharyngeal sphincter (11), nasopharyngeal reflux or incoordinated initiation of deglutition, or both (seven), a sliding hiatal hernia (11), and abnormal esophageal motility (seven). Esophageal manometry revealed abnormalities of upper esophageal sphincter (UES) function in only 16 patients. Of 36 patients undergoing standard acid reflux testing, one third had moderate-to-severe gastroesophageal reflux. Seven patients underwent staple resection of a Zenker's diverticulum at the time of cervical esophagomyotomy. Postoperative complications included transient vocal cord paresis (four), vocal cord paralysis (one), and salivary fistula (one). There were no postoperative deaths. After 2 to 48 months (average 16 months) of follow-up, 34 patients (85%) have had a good to excellent result, and six (15%) have not been benefited by operation.
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PMID:Extended cervical esophagomyotomy for cricopharyngeal dysfunction. 677 51

Current methods to evaluate patients with esophageal disease include barium swallow with fluoroscopy, which is useful in demonstrating structural defects. Disordered motility is better evaluated with a cine-esophagram. Recent application of radioisotopes has been useful in evaluation of esophageal reflux and the post-treatment of achalasia. Esophageal motility studies may evaluate lower esophageal sphincter and upper esophageal sphincter pressures and the response of the body of the esophagus to series of swallows. Since there is no "gold standard" for the evaluation of reflux esophagitis, some of the tests designed to evaluate reflux and the patient's reaction to acid in the esophagus include the acid infusion test, the standard acid reflux test, the acid clearance test, and 24-hour pH monitoring. Endoscopy with either the flexible or the rigid instrument is important for the diagnosis of obstruction or esophagitis and allows direct visualization of the esophagus. The treatment of reflux esophagitis is discussed. The differential diagnosis of dysphagia may include achalasia, diffuse esophageal spasm, and mechanical obstruction of the esophagus due to rings, webs, strictures, and benign or malignant tumors. The evaluation of dysphagia should include radiologic as well as endoscopic evaluation. Treatment of obstruction varies according to the nature of the lesion. The Mallory-Weiss syndrome or bleeding from the mucosal tears of the gastroesophageal junction and Boerhaave's syndrome, spontaneous esophageal perforation, are two disorders associated with vomiting. The Mallory-Weiss syndrome usually resolves without specific therapy, but a high index of suspicion is required for patients with chest pain after vomiting, as spontaneous perforation necessitates immediate surgery. Most diverticula need no treatment, but the Zenker diverticulum, if symptomatic, should probably be surgically repaired.
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PMID:Evaluation and management of diseases of the esophagus. 703 70

A series of 250 patients with dysphagia examined by cine-radiography and conventional single film technique revealed oesophageal webs in 38 and 26 patients respectively. In four patients there were two webs. There were eight males and 30 females which corresponds to an incidence of 8 and 20%, respectively (mean 15%), in patients referred for X-ray examination of the hypopharynx or oesophagus. Concomitant functional abnormalities in the act of swallowing were seen in 25 patients, i.e. pharyngeal constrictor muscle paresis of varying degree, cricopharyngeal incoordination, misdirected swallowing, epiglottic dysfunction and Zenker diverticulum. In five patients there was a malignant lesion as well, i.e. in the larynx, oesophagus, pharynx or stomach. With the aid of cine-radiography it is possible to show the presence of webs in a significantly higher proportion of patients with dysphagia compared with the conventional spot film technique. With cine-radiography it is also possible to demonstrate concomitant functional abnormalities which are frequently present in these patients.
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PMID:Cervical oesophageal webs in patients with dysphagia. 730 35

Pharyngoesophageal diverticulum is an acquired defect resulting from an incoordination of the cricopharyngeal muscle. Common symptoms are dysphagia, regurgitation, and aspiration. The defect is repaired through a cervical incision and should include a diverticulectomy and a myotomy. Results are excellent and complications are unusual.
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PMID:Pharyngoesophageal diverticulum: technique of repair. 758 31

Pharyngoesophageal dysphagia is chiefly a disorder of the elderly. This review examines recent advances in the understanding of the normal physiology of oropharyngeal bolus transport. Techniques for the evaluation of symptomatic patients are discussed with an emphasis on the complementary nature of manometry and videoradiography. The technical limitations of manometry are detailed. Therapy for the condition is aimed at the underlying cause, and patients with neurologic deficits (largest subgroup of patients) should have a good response to myotomy provided they fulfill basic criteria. Surgery for Zenker's diverticulum is always necessary, and a short discussion of technique has been included.
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PMID:Pharyngoesophageal swallowing disorders. 758 64

Zenker's diverticulum has been associated with a variety of symptoms such as dysphagia, regurgitation, aspiration, halitosis, and occasionally cough. In this case, a large Zenker's diverticulum containing a bezoar caused a persistent, debilitating cough presumably due to compression of adjacent neck structures.
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PMID:Zenker's bezoar. 759 81

The laryngeal manifestations of GER may present with a number of nonspecific signs or symptoms. Patients with hoarseness, dysphagia, globus sensation, laryngeal granulomas, and subglottic stenosis should be evaluated for GER. In addition, physicians should be aware of the possible association of GER with Zenker's diverticulum and laryngeal carcinoma. While pH manometry is the mainstay for diagnosis of GER, the sensitivity is lower for patients with head and neck manifestations of GER probably because of the intermittancy of the reflux. The use of a pharyngeal probe may improve the sensitivity of the test. Treatment of head and neck manifestations of GER is no different than reflux esophagitis and medical therapy is typically successful in resolving symptoms.
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PMID:The association of gastroesophageal reflux and otolaryngologic disorders. 774 73


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