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La disfagia alta es un síntoma frecuente de consulta al otorrinolaringólogo o gastroenteròlogo. Los diagnósticos diferenciales son trastornos de la deglución por daño neurològico, anillos esofágicos superiores, globus faríngeo, neoplasia, disfagia lusoria y trastornos motores inespecífico y otras más raras aún. Hay escasa literatura actualizada en pacientes adultos. El diagnóstico se basa en el estudio radiológico baritado, endoscopia y complementariamente con manometría. Las opciones de tratamiento son motivo de discusión, dada la poca evidencia disponible. En este artículo se presentan los resultados observados en una cohorte de 10 pacientes con diagnóstico confirmado de acalasia del cricofaríngeo sometidos a dilatación endoscópica (7 pacientes) o miotomía quirúrgica por cervicotomía (3 pacientes). Se evaluó evolución de la disfagia, complicaciones post procedimiento y resultados a largo plazo. No hubo complicaciones mayores, la disfagia mejoro en ambos grupos, en el grupo de dilatación se complementó el tratamiento con dilataciones periódicas en 2 pacientes. No hubo diferencias significativas en los 2 grupos estudiados. Conclusión: ambas opciones terapéuticas presentan buenos resultados en el tratamiento de estos pacientes.
Dysphagia at cervical level is a frequent symptom causing visit to otolaryngologist or gastroenterologist. The differential diagnoses are swallowing disorders due to neurological damage, upper esophageal rings, pharyngeal globus, neoplasia, non-specific motor disorders and other even rarer ones. There is little updated literature in adult patients. The diagnosis is based on the barium radiological study, endoscopy and complementary manometry. Treatment options are a matter of discussion, given the little evidence available. This paper presents the results observed in a cohort of 10 patients with a confirmed diagnosis of cricopharyngeal achalasia who underwent endoscopic dilation (7 patients) or surgical myotomy by cervicotomy (3 patients). The evolution of dysphagia, post-procedure complications and long-term results were evaluated. There were no major complications, dysphagia improved in both groups, in the dilation group the treatment was supplemented with periodic dilations in 2 patients. There were no significant differences in the 2 groups studied. Conclusion: both therapeutic options present good results in the treatment of these patients.
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OBJECTIVES@#At present, there are many reports about the treatment of cricopharyngeal achalasia by injecting botulinum toxin type A (BTX-A) into cricopharyngeal muscle guided by ultrasound, electromyography or CT in China, but there is no report about injecting BTX-A into cricopharyngeal muscle guided by endoscope. This study aims to evaluate the efficacy of endoscopic BTX-A injection combined with balloon dilatation in the treatment of cricopharyngeal achalasia after brainstem stroke, and to provide a better method for the treatment of dysphagia after brainstem stroke.@*METHODS@#From June to December 2022, 30 patients with cricopharyngeal achalasia due to brainstem stroke were selected from the Department of Rehabilitation Medicine, the First Hospital of Changsha. They were randomly assigned into a control group and a combined group, 15 patients in each group. Patients in both groups were treated with routine rehabilitation therapy, while patients in the control group were treated with balloon dilatation, and patients in the combined group were treated with balloon dilatation and BTX-A injection. Before treatment and after 2 weeks of treatment, the patients were examined by video fluoroscopic swallowing study, Penetration-aspiration Scale (PAS), Dysphagia Outcome Severity Scale (DOSS), and Functional Oral Intake Scale (FOIS) were used to assess the swallowing function.@*RESULTS@#In the combined group, 1 patient withdrew from the treatment because of personal reasons. Two weeks after treatment, the scores of DOSS, PAS, and FOIS in both groups were better than those before treatment (all P<0.01), and the combined group was better than the control group (all P<0.001). The effective rate was 85.7% in the combined group and 66.7% in the control group, with no significant difference between the 2 groups (P>0.05).@*CONCLUSIONS@#BTX-A injection combined with balloon dilatation is more effective than balloon dilatation alone in improving swallowing function and is worthy of clinical application.
Subject(s)
Humans , Deglutition Disorders/therapy , Esophageal Achalasia/drug therapy , Dilatation/adverse effects , Botulinum Toxins, Type A/therapeutic use , Brain Stem Infarctions/drug therapy , Treatment OutcomeABSTRACT
Objective:To explore the clinical effects of Xingshen Tongqiao Huoxue decoction in the treatment of dysphagia caused by cricopharyngeal achalasia （CPA） after cerebral infarction and its influence on neurotransmitters. Method:One hundred and fourteen eligible patients were randomly divided into a control group （56 cases） and a treatment group （58 cases）. Patients in both groups received balloon catheter dilatation and rehabilitation training. In the observation group， the Tiandan Tongluo capsules were further orally taken， five capsales per time， three times per day. In the control group， the Xingshen Tongqiao Huoxue decoction was provided， one dose per day. The treatment lasted for four weeks. Following the videofluoroscopic swallow study （VFSS） and water-swallowing test （WST） before and after treatment， the swallowing quality of life questionnaire （SWAL-QOL）， functional oral intake scale （FOIS） and National Institutes of Health Stroke Scale （NIHSS） scores were calculated. The serum brain-derived neurotrophic factor （BDNF）， substance P （SP）， dopamine （DA）， 5-hydroxytryptamine （5-HT） and nerve growth factor （NGF） levels before and after treatment were detected， and the complications were recorded. Result:The clinical efficacy of the treatment group was superior to that of the control group （<italic>Z</italic>=2.079， <italic>P</italic><0.05）. Both VFSS and WST findings in the treatment group were milder than those in the control group （<italic>Z</italic>=2.004， <italic>P</italic><0.05 and <italic>Z</italic>=1.973， <italic>P</italic><0.05）. The VFSS， SWAL-QOL， and FOIS scores and the BDNF， DA， SP， 5-HT and NGF levels of the treatment group were elevated in contrast to those of the control group （<italic>P</italic><0.01）， whereas the NIHSS score declined （<italic>P</italic><0.01）. The complication rate in the treatment group was （8/58） 13.79%， significantly lower than （17/56） 30.36% in the control group （<italic>χ</italic><sup>2</sup>=4.565， <italic>P</italic><0.05）. Conclusion:On the basis of balloon catheter dilatation and rehabilitation training， the Xingshen Tongqiao Huoxue decoction can significantly enhance the swallowing function， improve the quality of life， and reduce complications in patients with dysphagia caused by CPA after cerebral stroke.
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Objective:To apply Botulinum toxin type A (BTX-A) injection for cricopharyngeal achalasia dysphagia guided by ultrasound and electrical stimulation. Methods:A case with cricopharyngeal achalasia dysphagia was reviewed. Results:He ate food almost in normal way six days after injection, and cricopharyngeus was open seven days after injection. Conclusion:BTX-A injection under ultrasound- and electrical stimulation-guide is effective on cricopharyngeal achalasia dysphagia.
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Objective:To investigate the effect of cricopharyngeal injection of Botulinum toxin under ultrasonic guidance for treatment of dysphagia caused by Wallenberg's syndrome. Methods:A case was reviewed. Results:This patient was diagnosed as cricopharyngeal achalasia after dorsal lateral rostral infarction, and responded poor to routine treatment for swallowing disorders, including balloon dilatation. He accepted cricopharyngeal Botulinum toxin injection under ultrasonic guidance. As evaluated with Toshima Ichiro Ingestion-Swallowing Function Rating Scale, Rosenbek Penetration-Aspiration Scale and videofluoroscopic swallowing study (VFSS), his swallowing improved after treatment, and became normal as follow-up one and three months after treatment. Conclusion:Cricopharyngeal Botulinum toxin injection under ultrasonic guidance is feasible for cricopharyngeal achalasia of Wallenberg's syndrome with immediate and long-term effect.
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Objective:To apply surface electromyography (sEMG) in assessment of swallow function for patients with cricopharyngeal achalasia. Methods:From January, 2015 to December, 2019, 48 patients with dysphagia after ischemic stroke accepted videofluoroscopic swallowing study (VFSS); those with cricopharyngeal achalasia were as observation group (n = 24), and those without cricopharyngeal achalasia were as control group (n = 24). Other 24 healthy subjects were as healthy group. They accepted sEMG at infrahyoid muscles and submental muscles as they were resting, and swallowing nothing (saliva), water, thick fluid and semiliquid food. The root mean square (RMS) of sEMG was recorded. The correlation of RMS and VFSS was anlyzed. Results:The RMS of both muscle groups increased with the difficuty of swallowing in all the groups (F > 77.652, P < 0.001). For every condition, the RMS of both muscle groups was the most in the observation group, and then for the control group and the healthy group (F > 42.505, P < 0.001). The RMS of both muscle groups positively correlated with VFSS score (r > 0.548, P < 0.05). Conclusion:sEMG can be used to quantitatively assess the contraction of submental muscles and infrahyoid muscles in cricopharyngeal achalasia patients after ischemic stroke, which may help to evaluate swallowing function.
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OBJECTIVE@#To screen the optimal acupuncture regimen for cricopharyngeal achalasia (CPA) after brain stem infarction and compare the therapeutic effect between the combined therapy of catheter balloon dilation and acupuncture and the simple application of catheter balloon dilation.@*METHODS@#The patients suffering from neuropathic dysphagia in CPA after brain stem infarction were selected as the subjects. After confirmed in the diagnosis with video fluoroscopic swallowing study (VFSS), they were randomized into 6 groups, 15 cases in each one, named group A (routine treatment), group B (catheter balloon dilation), group C1 (treated with acupuncture in local area), group C2 (treated with acupuncture based on differentiation), group C3 (treated with acupuncture at the local area and the acupoints based on differentiation) and group D (catheter balloon dilation combined with the optimal acupuncture). Two phases were included in the study. In the first phase of study, the therapeutic effect was compared among the three acupuncture groups, named C1, C2 and C3 group, so as to screen the optimal acupuncture regimen. In the group C1, the main acupoints included Fengchi (GB 20), Wangu (GB 12), Yifeng (TE 17) and three-tongue points (Extra). In the group C2, the main acupoints were Neiguan (PC 6), Tongli (HT 5), Zusanli (ST 36) and Sanyinjiao (SP 6) as well as the supplementary acupoints in accordance with the syndrome differentiation. In the group C1 and group C2, after , the electroacupuncture was used, with continuous dense wave, 5 to 8 Hz in frequency. The needles were retained for 30 min. Acupuncture was given once a day, 5 treatments a week. Before treatment, in 6 weeks of treatment or after removal of gastric tube, the rehabilitation was evaluated. In the group C3, the acupoints, manipulation and treating course were same as the group C1 and group C2. In the 2nd phase of study, theresults of rehabilitation treatment were compared among the group A, group B and group D. The treatment was given once a day, 5 times a week. Before treatment, after gastric tube removal or in 6 weeks of treatment, the evaluation was conducted. The feedingswallowing function grade and VFSS were adopted in the evaluation among the above 6 groups.@*RESULTS@#① In the VFSS comparison at 1st phase of study after treatment, the food transporting ability at oral dysphagia, the results in the group C3 and group C1 were better obviously than the group C2 (both 0.05). The severity of dysphagia in the group C3 was milder than the group C2 and group A (both <0.05). ② In the VFSS comparison at the 2nd phase of study, for the food transporting ability, the results in the group D and the group B were obviously better than the group A (both <0.05). Regarding the function at the pharyngeal dysphagia and aspiration, the results in the group D were better than the group B and group A, those in the group B were better than the group A (all <0.05). The difference in the extubation rate among the group A, group B and group D after treatment was significant statistically (<0.01), of which, the extubation rate in the group D was the highest and the rate in the group A was the lowest. The dysphagia degree in the group D was milder than the group B and group A and that in the group B was milder than the group A (all <0.05).@*CONCLUSION@#In the study of the different acupuncture methods, the acupuncture at the local acupoints and the acupoints selected based on differentiation is the optimal acupuncture regimen for cricopharyngeal achalasia after brain stem infarction. The catheter balloon dilation combined with acupuncture present the synergistc effect on cricopharyngeal achalasia after brain stem infarction, obviously relieve dysphagia and reduce aspiration.
Subject(s)
Humans , Acupuncture Points , Acupuncture Therapy , Methods , Brain Stem Infarctions , Catheterization , Dilatation , Esophageal Achalasia , Therapeutics , Treatment OutcomeABSTRACT
Objective To compare the effect of treating cricopharyngeal achalasia in stroke survivors using transnasal or transoral balloon dilatation.Methods Thirty stroke survivors with cricopharyngeal achalasia were randomly divided into a transnasal and a transoral balloon dilatation group (group N and group O),each of 15.Both groups were given routine swallowing rehabilitation training as well as the transnasal or transoral balloon dilatation.Their heart rate was monitored during the dilatation.Nasal bleeding,mucous membrane swelling and pain were also observed.Their swallowing function was evaluated using the Fujishima Ichiro swallowing efficacy score (FISE) and videofluoroscopy (VFSS) before and after the intervention.Results After the treatment,the average FISE and VFSS scores of both groups had improved significantly comnpared to before the treatment but there were no significant differences between the groups.During the treatment,the average heart rate of group O increased significantly less than that of group N.The treatment acceptance of group O was 98.2％,significantly higher than that of group N (80.1％).One case of mucosal bleeding was observed in group O,and laryngeal edema occurred significantly less often than in group N (9 cases vs.7).The average pain score was also significantly lower in group O.Conclusions Balloon dilatation facilitates swallowing among stroke survivors with cricopharyngeal achalasia.The transoral approach can help to reduce the occurrence of complications such as mucosal bleeding,laryngeal edema and pain,and has better patient acceptance.
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Objective To investigate the effects of peroral catheter balloon dilatation on patients with dysphagia caused by cricopharyngeal achalasia after stroke.Methods Thirty-two stroke survivors with cricopharyngeal achalasia were randomly divided into a control group and a treatment group,each of 16.Both groups were given routine dysphagia rehabilitation training,but the treatment group was additionally given peroral balloon dilatation therapy six times a week for 2 weeks.Both groups were given swallowing function evaluations and videofluoroscopic swallowing examinations (VFSS) before and after the treatment.Results After the treatment,14 of the 16 patients in the treatment group demonstrated improved swallowing,significantly better than the control group,where only 9 patients had improved.The VFSS showed dysphagia to have been relieved in both groups,but significantly more in the treatment group.Transit duration in the pharnx was significantly shortened from 0.28 s to 0.16 s in the treatment group,but no significant difference was tound in the control group.Conclusion Peroral catheter balloon dilatation is effective for relieving cricopharyngeal achalasia after stroke.
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Objective To observe the therapeutic efficacy of electrical stimulation and balloon dilatation in treating cricopharyngeal achalasia after a brainstem stroke.Methods Thirty dysphagia patients with cricopharyngeal achalasia after a brainstem stroke were randomly divided into an experimental group and a control group, each of 15.The experimental group was given real-time electrical stimulation and balloon dilatation, while the control group was treated using common electrical stimulation and balloon dilatation.Results Twenty-six patients in the 2 groups returned to oral feeding after treatment.Videofluoroscopy revealed that the cricopharyngeal sphincter had relaxed and the food passed successfully when swallowing.No aspiration was observed.There was no significant difference in swallowing between the two groups, but the average treatment time, days of treatment and cost of therapy in the experimental group were significantly less than in the control group.Conclusions Either real-time electrical stimulation or common electrical stimulation combined with balloon dilatation can treat dysphagia effectively, but the former can shorten the course of treatment and lower its cost.
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@#Objective To explore the rehabilitation for dysphagia in young patient after tracheotomy and cricopharyngeal achalasia with-out cough reflex. Methods A child was reviewed, who accepted tracheotomy after resection of cerebellar pilocytic astrocytoma for dyspha-gia. The features characterized as severe silent aspiration and failure of cricopharyngeus muscle relaxation. Therapies included Passy-Muir valve placement, breathing exercises, balloon dilatation, surface electromyography biofeedback, and electrical stimulation. Results The aspi-ration was observed when she drank thin liquid with weak cough reflex, and disappeared as eating thick liquid and paste food, with complete cricopharyngeus muscle opening, 7 weeks after treatment. She was removed the tracheotomy tube and nasal feeding tube 11 weeks after treatment, and got sufficient nutrition by fully oral intake. Conclusion The application of Passy-Muir valve and comprehensive swallowing training is helpful for patient post tracheotomy with silent aspiration in decreasing the risk of aspiration, improving cough reflex and prompt-ing swallowing function.
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Objective To observe the therapeutic effects of balloon dilatation with ice water and room temperature water on cricopharyngeal achalasia after brainstem stroke.Methods Forty dysphagic patients with cricopharyngeal achalasia after brainstem stroke were recruited.Twenty patients assigned to experimental group were treated by balloon dilatation with ice water and low frequency elecrtrical stimulation.Twenty patients assigned to control group were treated by balloon dilatation with room temperature water and low frequency electrical stimulation.Results After treatment,36 out of the 40 patients of the two groups could eat pasty food independently without choking.Videofluoroscopic swallowing study (VFSS) showed that the cricopharyngeal sphincter relaxed and the foods passed successfully when swallowing bolus,and no aspiration happened.In comparison,the level of cricopharyngeal opening,the number of patients with nasogastric tube remained and eating normally,and the scores of functional oral intake scale (FOIS) between the two groups showed no significant difference (P ＞ 0.05).The average treatment sessions,average hospitalization days and average treatment cost in treatment group were significantly less than those in the control group(P ＜0.05).Conclusion Cricopharyngeal achalasia can be treated effectively by balloon dilatation with ice water or with room temperature water combined with low frequency electrical stimulation,but treatment course of balloon dilatation with ice water were significantly shorter than that of balloon dilatation with room temperature water.
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A 10-year-old castrated male papillon presented with nasal discharge, coughing and chronic dysphagia. On physical examination, the dog exhibited sneezing, gurgling and movement of the throat with repeated attempts to swallow fluids. A diagnosis of cricopharyngeal achalasia (CPA) was made based on video fluoroscopic demonstration of failure of relaxation of the upper esophageal sphincter. This report describes the diagnosis of CPA in an old dog, which is rarely diagnosed in older animals.
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Animals , Child , Dogs , Humans , Male , Cough , Deglutition Disorders , Diagnosis , Esophageal Achalasia , Esophageal Sphincter, Upper , Pharynx , Physical Examination , Relaxation , SneezingABSTRACT
Objective To investigate the effects of catheter balloon dilatation on patients with dysphagia caused by neurogenic cricopharyngeal achalasia.Methods Thirty-two patients with dysphagia caused by neurogenic cricopharyngeal achalasia were divided randomly into a treatment group (n =16) and a control group (n =16).The treatment group received catheter balloon dilatation therapy and routine dysphagia rehabilitation training; the control group was treated with routine dysphagia rehabilitation training only.Both groups were tested before treatment,after 3 weeks of treatment (after treatment) and at 6 months after treatment (follow-up).All cases were evaluated using Saitoh's 7-grade swallowing assessment and videofluoroscopy.Results After treatment,5 cases in the treatment group had been cured (31％) and 8 cases showed marked effectiveness (50％) ; in the control group,1 case was cured (7％) and 5 cases showed marked effectiveness (31％).These differences were statistically significant.At follow-up,5 cases in the treatment group had been cured (31％) and 9 cases showed marked effectiveness (56％) ; for the control group,1 case was cured (7％) and 6 cased showed marked effectiveness (38％).Those differences were also statistically significant.After treatment and also at follow-up,the average time for a bolus to pass the pharynx in the treatment group was significantly shorter than that in the control group.Conclusion Catheter balloon dilatation therapy is effective for treating neurogenic cricopharyngeal achalasia in both the short and long term.
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Objective To explore the change of the pre-swallow peak pressure of upper esophageal sphincter (UES) in patients with post-stroke cricopharyngeal achalasia,and investigate the effect of pre-swallowing peak UES pressure on swallowing function by quantitative analysis.Methods Fifty-seven stroke patients with cricopharyngeal achalasia were recruited and divided into balloon dilation group,combined training group and routine swallowing training group with 19 patients in eachp.All the three groups accepted routine swallowing training.In addtion,the routine swallowing training group and balloon dilation group accepted larynx elevation training and balloon dilation training,respectively,while the combined training group accepted larynx elevation training and balloon dilation training simultaneously.The pre-swallow peak UES pressure was measured by using PC polygraph high rate gastrointestinal dynamical detection system (PC Polygraf HR,CTD-synectics,Sweden) before and after 8 weeks of treatment.The swallowing function was assessed using swallowing function classification and water swallowing test.Results Before treatment,there was no significant difference among the 3 groups in terms of the pre-swallow peak UES pressure,swallowing function classification,water swallowing test and VFSS (P ＞ 0.05).After treatment,pre-swallow peak UES pressure,swallowing function classification,water swallowing test and VFSS of the balloon dilation group and combined training group improved significantly compared with those before treatment (P ＜ 0.05),and the improvement in the combined training group was to a significantly better extent than in the balloon dilation group(P ＜O.05).Conclusion Balloon dilation and larynx elevation training plus routine swallowing training can increase pre-swallow peak UES pressure,decrease the UES resting pressure of stroke patients with cricopharyngeal achalasia,which is of great importance for their recovery.
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Objective To investigate the effect of different intervention times on the efficacy of catheter balloon dilatation therapy for cricopharyngea] achalasia after stroke.Methods Forty-eight cases diagnosed as cricopharyngeal achalasia were divided into 4 groups,groups A,B,C,and D according to the time of intervention from the onset (i.e.0.5,0.5-1,1-3,and 3-6 months),with 12 cases in each group.A 14# urethral catheter was inserted into the esophagus and water was injected into the balloon to make it turgid.The catheter was then pulled upwards through the stricture in the esophagus to dilatate the cricopharygeal muscle.The patients also received low frequency electrical stimulation combined with dysphagia rehabilitation behavioral therapy once daily.The treatment end point was either when the patient resumed an oral diet or after 6 weeks of treatment.The effects of the treatment were evaluated in terms of the number of times the dilatation therapy was administered,the pharyngeal transit duration,swallowing function and fluoroscopic examination before and after treatment.Results Groups A,B and C required significantly fewer treatment sessions than group D.Groups A and B required significantly fewer sessions than group C,but the difference between groups A and B was not statistically significant.After treatment,there were 11 patients can eat water,liquid,paste and solid food both in groups A and B.But the number of patients who can eat the4 traits of food was 9,9,10,9 in group C and 6,6,7,5 in group D respectively.Swallowing function in groups A,B and C was adjudged,on average,significantly better than in group D.Compared with group C,swallowing function in groups A and B was also significantly improved,but the difference between groups A and B was not statistically significant.The pharyngeal transit duration in all 4 groups was shorter than before treatment,but the duration in groups A,B and C was significantly shorter than in group D.Compared with group C,the pharyngeal transit duration in groups A and B was significantly shorter,but the difference between groups A and B was again not statistically significant.Fluoroscopy showed the efficiency in groups A and B to be over 91 ％.In group C it was 83％ and in group D 58％.The difference between group D and groups A,B and C was significant.The efficiency in groups A and B was significantly better than in group C,but the difference between groups A and B again was not statistically significant.Conclusions Early intervention using catheter balloon dilatation therapy can facilitate the improvement of swallowing function in patients with cricopharyngeal achalasia after stroke and improve their quality of life.
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@#Objective To explore the effects of catheter balloon dilatation therapy on cricopharyngeal achaiasia in patients with stroke and 1 year follow-up study. Methods 28 cases of dysphagia caused by stroke were diagnosed as cricopharyngeal achalasia through videofluoroscopic swallowing study (VFSS). A l4# urethral catheter was used to insert into the esophagus and an amount of water was injected into the balloon of urethral catheter to make it turgid. Then the catheter was pulled upwards and passed through the stricture of esophagus to dilatate the cricopharygeus muscle. At the same time, vitalstim low frequency electrical stimulation was used and combined with routine dysphagia rehabilitation training once daily. The treatment end point was either the patient resuming an oral diet or after 6 weeks of treatment. All cases were evaluated by swallowing function and VFSS before and after treatment and followed after 1 year of treatment. Results After catheter balloon dilatations therapy, 22 patients regained the ability to take solid food and water orally, 24 of them could take pasty food. There was significant difference between pre-treatment and post-treatment (P<0.01). The time of bolus passing the pharynx significantly shortened from 0.22 s to 0.14 s after treatment. The scores of VFSS significantly increased after treatment (P<0.01). VFSS showed that the total effective rate was 89.28%. 1 year after treatment, 23 patients could take solid food and water orally, and 12 patients approach to normal in the time passing the pharynx and VFSS score. Conclusion Catheter balloon dilatation has long-term effect on cricopharyngeal achalasia caused by stroke.
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A 7-month-old miniature poodle female dog was referred with dysphagia. After clinical, radiographic, and endoscopic examination, it was diagnosed a probable case of cricopharyngeal achalasia. The patient underwent surgical treatment and presented normal swallowing and no regurgitation after 24 hours post-surgery. Positive recovery and progressive body weight gain until 180 days after surgery was observed.
Uma cadela da raça poodle miniatura com sete meses de idade foi atendida no Hospital Veterinário apresentando quadro de disfagia. Após exames clínico, radiográfico e endoscópico detalhados, houve diagnóstico provável de acalasia cricofaríngea. A paciente, submetida a tratamento cirúrgico, apresentou deglutição normal e nenhuma regurgitação 24 horas pós-cirurgia. Houve recuperação satisfatória e ganho de peso progressivo até 180 dias após a cirurgia.
Subject(s)
Animals , Dogs/classification , Deglutition Disorders/pathology , Endoscopy/adverse effects , Endoscopy , RadiographyABSTRACT
Objective To observe the effect of different ways of balloon catheter dilation techniques on cricopharyngeal achalasia and its mechanisms.Methods Thirty patients with deglutition disorder after brain stem infarction,whose cricopharyngeal achalasias were proven by videofluoroscopic swallowing study(VFSS),were randomly divided into three groups: No.14 conventional catheter group A,No.14 modified bicavitary silica-gel catheter group B and No.22 conventional catheter group C with 10 cases in each group,respectively.All the patients of 3 groups received multiple times corresponding balloon catheter dilatation per nasal or per os(No.22 conventional catheter group C only per os).Results After an average of 30 d of balloon catheter dilatation,the level of dysphagia and VFSS evaluation of all patients improved significantly(P ＜ 0.05).However,the No.14 conventional catheter group A and No.22 conventional catheter group C improved to a greater extent than No.14 modified bicavitary silica-gel catheter group B(P ＜ 0.05).The saccule perimeter,saccule diameter and saccule intracapsular pressure of No.14 conventional catheter group A and No.22 conventional catheter group C increased significantly(P ＜ 0.05)when compared to those of No.14 modified bicavitary silica-gel catheter group B,but there was no significant diffference beween No.14 conventional catheter group A and No.22 conventional catheter group C(P ＞ 0.05).Conclusions The balloon catheter dilation technique can significantly improve swallowing function of deglutition disorders patients with cricopharyngeal achalasia after brain stem infarction,which is related positively to saccule diameter and saccule intracapsular pressure.
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@#ObjectiveTo study the effects and feasibility of balloon dilatation on cricopharyngeal achalasia in children with dysphagia. MethodsOne 21-month-old child was reported. ResultsAfter 14 times dilatation therapy, the video fluoroscopic swallowing study showed that the bolus can pass the cricopharyngeus. The residuals in the epiglottis and piriform sinuses reduced. No bucking and aspiration happened and the cricopharygeus muscle relaxed normally. The gastric tube can be removed and the child got full per-oral nutrition. ConclusionBalloon dilatation is effective to relax the cricopharygeus muscle and improve the swallowing function of children with dysphagia because of cricopharyngeal achalasia.