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Home Books CURRENT Diagnosis & Treatment: Gastroenterology, Hepatology, & Endoscopy, 3e

Chapter 13: Oropharyngeal & Esophageal Motility Disorders

Hiroshi Mashimo

INTRODUCTION

General Considerations

Oropharyngeal and esophageal motility disorders can have a significant impact on patients’ quality of life. Diagnosis and management can be challenging because mechanical and functional problems may interact to cause patients’ symptoms.

Dysphagia (difficulty swallowing) must be distinguished from odynophagia (pain on swallowing, suggestive of a defect in mucosal integrity, eg, from trauma, irradiation, inflammation, or infection) and aphagia (inability to swallow, generally suggestive of acute obstruction). Symptoms that do not necessarily correlate with the immediate process of swallowing, such as rumination and globus sensation, should also be discerned.

Dysphagia can considered arising from disorders in three anatomic phases of normal swallow (Table 13–1): (1) oral (also called preparatory) phase, (2) oropharyngeal phase (also called transfer dysphagia) involving the oropharynx, larynx, and upper esophageal sphincter (UES), and (3) esophageal phase, involving the esophageal body, lower esophageal sphincter (LES), and gastroesophageal junction (GEJ). The causes of dysphagia are many, and some may even overlap for both oropharyngeal and esophageal dysphagia (Figure 13–1). Specific entities are considered here.

Figure 13–1.

Radiologic appearance of oropharyngeal motility disorders. A. Frontal view of the pharynx demonstrates aspiration of retained bolus. Note that there is retention of contrast in the valleculae (v) and piriform sinuses (ps). No swallow is taking place, yet there is entry of contrast into the laryngeal vestibule (vé) and between the vocal folds and in the ventricle (arrows). B. A stop-frame print from a cinepharyngogram in the lateral position shows incomplete laryngeal closure during swallowing with laryngeal penetration (arrows) and aspiration (arrowheads) down into the trachea. The bolus is passing through the open cricopharyngeus into the cervical esophagus. Degenerative change is noted in the cervical spine. C. Cricopharyngeal bar. D. Zenker diverticulum. (Reproduced, with permission, from (A) Jones B (ed). Normal and Abnormal Swallowing: Imaging in Diagnosis and Therapy, 2nd ed. Springer-Verlag, 2003; (B) Jones B, Donner MW (eds). Normal and Abnormal Swallowing: Imaging in Diagnosis and Therapy. Springer-Verlag, 1991.)

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Table 13–1.Phases of swallow.
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Table 13–1. Phases of swallow.

Oral phase

 Food enters mouth

 Chewing and mixture with saliva

 Bolus formation

Oropharyngeal phase

 Tongue elevation and bolus delivery to pharynx

 Soft palate elevation, sealing nasopharynx

 Anterior and upward elevation of larynx and hyoid

 Posteriorly and downward closure by epiglottis

 Stopping respiration

 Shortening of pharynx

Esophageal phase

 Quick relaxation of UES

 More prolonged relaxation of LES

 Bolus passage into esophagus

 Peristaltic contraction of esophagus

 Bolus enters stomach

Data from Langmore SE. Endoscopic evaluation of oral and pharyngeal phases of swallowing. GI Motility Online.

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Massey  BT, Shaker  R. Oral pharyngeal and upper esophageal sphincter motility disorders. GI Motility Online. Available at: http://www.nature.com/gimo/index.html; doi:10.1038/gimo19, 2006.
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Paterson  WG, Goyal  RK, Habib  FI. Esophageal motility disorders. ...

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