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

We report a 49 year old man who presented with left leg weakness, frontal headache, impaired concentration and dysphagia. He was thought to have a benign oesophageal stricture on barium swallow and oesophagoscopy though this was not initially biopsied. During admission his vision deteriorated so that he could only recognize bright light. Repeat oesophagoscopy demonstrated an oesophageal adenocarcinoma. The diagnosis of meningeal carcinomatosis was confirmed at post-mortem. Sudden bilateral blindness is a common feature of meningeal carcinomatosis but, as this is rare, it is not commonly considered in the differential diagnosis of visual loss. The visual loss can be explained by vascular insufficiency in association with tumour cuffing of the subarachnoid space of the optic nerve sheath, by neuronal toxins, or other, as yet unknown, mechanisms.
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PMID:Rapid onset of blindness due to meningeal carcinomatosis from an oesophageal adenocarcinoma. 175 2

The prevalence of dysphagia in the elderly ("presbyphagia") is probably still underestimated, though this disorder represents a major geriatric problem; special attention is necessary to prevent malnutrition, dehydration and aspiration pneumonia. Primary presbyphagia due to physiological, age-related changes of the swallowing mechanism must be differentiated from secondary presbyphagia attributable to diseases which are more frequent in the elderly. Transnasal pharyngo-laryngo-fiberendoscopy, videofluoroscopy and the "modified barium swallow" are of particular value in the diagnostic approach to presbyphagia. The possibilities of treatment are limited. They are aimed at dietary adjustments, compensatory mechanisms based on the properties of the volume and consistency of the food, proper feeding position and help by other persons. Individual swallowing exercises by a speech therapist are particularly valuable. Surgical procedures for the treatment of underlying organic disorders are less often indicated in presbyphagia.
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PMID:[Dysphagia in the elderly]. 176 68

Masticatory efficiency was evaluated in 21 adults for four chewing parameters: mixing of a color-patterned chewing gum mass, shaping of a chewing gum mass, particle reduction of a silicone tablet, and number of chewing strokes before the first swallow of an almond. The results of these tests were correlated with the dimension of the pharyngoesophageal (PE) segment during swallow of liquid barium and solid meat. The transverse width of the PE segment during swallow of liquid barium correlated significantly with the chewing parameters. The sagittal width of the PE segment during swallow of liquid barium correlated only weakly with the chewing parameters. The PE segment dimension during swallow of a solid meat bolus did not correlate with the chewing parameters. The results suggest that there is feedback during chewing and swallowing between the PE segment and the oral cavity.
Dysphagia 1991
PMID:Chewing and the dimension of the pharyngoesophageal segment. 177 99

Fifty-one patients with systemic sclerosis (scleroderma) underwent videofluoroscopy during barium swallow to evaluate the incidence of oropharyngeal deglutition abnormalities and to correlate the radiologic patterns of esophageal motility abnormalities with patients' clinical features. Thirteen patients (26%) showed swallowing dysfunction, (e.g., oral leakage, retention, penetration, mild or moderate aspiration, and upper esophageal sphincter incoordination). These dysfunctions were more severe in patients with prominent esophageal dysmotility. Normal esophageal motility was not associated with swallowing alterations. Patients with an oropharyngeal disorder had a higher incidence of pulmonary disease. The clinical picture of the above-mentioned 13 patients was more severe, based on the duration of Raynaud's phenomenon and duration of skin sclerosis. Patients with primary Raynaud's phenomenon had no oral or esophageal abnormalities. The esophageal phase of swallowing was abnormal in 80% of the patients with scleroderma. Esophageal dysfunction, therefore, seems to be frequent in the early stages of the disease. However, patients with advanced or extensive disease may have normal esophageal function.
Dysphagia 1991
PMID:Oropharyngeal and esophageal function in scleroderma. 177

A case of 61-year-old man with a 2-year history of progressive difficulty in swallowing solid foods is presented. CT-scan and barium swallow test demonstrated an anterior osteophyte at C6. Resection of the osteophyte resolved the dysphagia. The rarity in the neurosurgical literature, the pathogenesis and the management of this condition are discussed.
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PMID:Dysphagia due to anterior cervical osteophyte. Case report. 181 51

Two cases of bronchogenic cysts involving esophagus are reported. The first case concerns a 30 year-old man, who admitted for dysphagia, regurgitation and abdominal pain. Barium esophagography, esophagoscopy and CT scan showed a cystic mass involving the lower third of the esophageal wall. Treatment consisted in the resection of the cyst by left thoracic approach. The second case concerns a 26 year-old woman, admitted for dysphagia. MRI and endoscopic ultrasonography had contributed to define the exact nature, internal composition and location of the cyst: upper and posterior mediastinum, close to the esophagus but respecting all the esophageal layers. Treatment consisted in the resection by video-thoracoscopy. Histologically, these two cysts were typical bronchogenic cysts. These two cases allowed us to discuss the benefits of new imaging methods (CT scan, MRI, endoscopic US) in the diagnosis of cystic masses of the mediastinum, and to emphasize video-surgery in their treatment.
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PMID:[Bronchogenic cysts of the esophagus. Classical surgery or video-surgery?]. 184 53

Occult (silent) gastroesophageal reflux disease (GER, GERD) is believed to be an important etiologic factor in the development of many inflammatory and neoplastic disorders of the upper aerodigestive tract. In order ot test this hypothesis, a human study and an animal study were performed. The human study consisted primarily of applying a new diagnostic technique (double-probe pH monitoring) to a population of otolaryngology patients with GERD to determine the incidence of overt and occult GERD. The animal study consisted of experiments to evaluate the potential damaging effects of intermittent GER on the larynx. Two hundred twenty-five consecutive patients with otolaryngologic disorders having suspected GERD evaluated from 1985 through 1988 are reported. Ambulatory 24-hour intraesophageal pH monitoring was performed in 197; of those, 81% underwent double-probe pH monitoring, with the second pH probe being placed in the hypopharynx at the laryngeal inlet. Seventy percent of the patients also underwent barium esophagography with videofluoroscopy. The patient population was divided into seven diagnostic subgroups: carcinoma of the larynx (n = 31), laryngeal and tracheal stenosis (n = 33), reflux laryngitis (n = 61), globus pharyngeus (n = 27), dysphagia (n = 25), chronic cough (n = 30), and a group with miscellaneous disorders (n = 18). The most common symptoms were hoarseness (71%), cough (51%), globus (47%), and throat clearing (42%). Only 43% of the patients had gastrointestinal symptoms (heartburn or acid regurgitation). Thus, by traditional symptomatology, GER was occult or silent in the majority of the study population. Twenty-eight patients (12%) refused or could not tolerate pH monitoring. Of the patients undergoing diagnostic pH monitoring, 62% had abnormal esophageal pH studies, and 30% demonstrated reflux into the pharynx. The results of diagnostic pH monitoring for each of the subgroups were as follows (percentage with abnormal studies): carcinoma (71%), stenosis (78%), reflux laryngitis (60%), globus (58%), dysphagia (45%), chronic cough (52%), and miscellaneous (13%). The highest yield of abnormal pharyngeal reflux was in the carcinoma group and the stenosis group (58% and 56%, respectively). By comparison, the diagnostic barium esophagogram with videofluoroscopy was frequently negative. The results were as follows: esophagitis (18%), reflux (9%), esophageal dysmotility (12%), and stricture (3%). All of the study patients were treated with antireflux therapy. Follow-up was available on 68% of the patients and the mean follow-up period was 11.6 +/- 12.7 months.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. 189 64

The modified barium swallow is currently the most comprehensive, widely available, and easily interpreted technique for the evaluation of patients with dysphagia by the head and neck surgeon. However, it requires the facilities, personnel, and use of a radiology suite, a trained speech pathologist, and exposure of the patient to radiation. It would therefore be helpful to have an adjunctive, physician based, nonradiographic method of examination that could provide information similar to and possibly even more complete than that supplied by the modified barium swallow. Such an adjunctive method could help otolaryngologist-head and neck surgeons confronted by a new patient with swallowing difficulties to orient themselves to the nature and severity of the problem while waiting for the modified barium swallow to be scheduled, performed, and reviewed. It could also be a helpful tool for management of patients with cancer of the head and neck, whose swallowing function may change rapidly in the early postoperative period. In such cases, intervals between modified barium swallow examinations (dictated by concern over radiation exposure) may be too far apart to allow up-to-the-minute decisions on case management. Finally, some patients who may be too ill to travel to the radiology suite might benefit from a bedside procedure that would yield information about swallowing function similar to that provided by the modified barium swallow. Videoendoscopic evaluation of dysphagia (VEED) is a protocol I developed and have used regularly since 1984. Experience with this method of dysphagia evaluation has shown that it answers the needs outlined above. Its usefulness also goes beyond that of the modified barium swallow by providing a more detailed understanding of the component anatomic and functional deficits that comprise a given patient's swallowing problem, information about upper aerodigestive tract sensory deficits, and a means for visual feedback training of pharyngeal and laryngeal musculature. The protocol is reviewed here. Case reports illustrating the clinical usefulness of VEED as an adjunct to the modified barium swallow are also presented, and the relative strengths and weaknesses of VEED and the modified barium swallow are compared.
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PMID:Videoendoscopic evaluation of patients with dysphagia: an adjunct to the modified barium swallow. 190 35

Esophageal intramural pseudodiverticulosis (EIP) is a rare disease, characterized by multiple, small flask-shaped diverticula in the esophageal wall, and best demonstrated on single-contrast barium examination. Though the condition is often associated with reflux esophagitis, Candida esophagitis, and esophageal dysmotility, corrosive-acid injury is not a commonly recognized cause. In a radiological study involving 59 patients with sequelae of corrosive-acid injury of the upper gastrointestinal (GI) tract, evaluated over a 5-year period, 14 cases (23.7%) of EIP were found. Esophageal stricture was a constant association; the diverticula tended to involve either the entire length of the stricture or its upper part. There was, however, no correlation between the length of the stricture and number of diverticula (p greater than 0.05). Endoscopic dilatation resulted in relief of dysphagia, and the diverticula regressed in number of disappeared altogether. Our experience suggests that EIP is a common sequelae of esophageal acid injuries, and that diverticula tend to form at the site of initial contact between acid and susceptible esophageal mucosa. Stricture dilatation leads to reduction or total disappearance of the diverticula.
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PMID:Corrosive acid-induced esophageal intramural pseudodiverticulosis. A study of 14 patients. 150 Jun 73

Three adult patients presented with dysphagia due to vascular compression of the esophagus. In one case, a dysphagia aortica was diagnosed. In the remaining two cases a congenital vascular anomaly--aberrant right subclavian artery and right aortic arc, respectively--was proved by arteriography. The final diagnosis was suspected after the barium meal and confirmed by computarized tomography in each case.
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PMID:[Dysphagia of vascular origin]. 193 Dec 46


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