[DYSPHAGIA] cricopharyngeal spasms

[icampbelltaylor@sympatico.ca (I Campbell-Taylor)]

One of the most comprehensive articles on the subject is:

Biomechanics of cricopharyngeal bars.
Dantas RO; Cook IJ; Dodds WJ; Kern MK; Lang IM; Brasseur JG
Gastroenterology, 99:1269-74  1990
Patients with a prominent cricopharyngeal bar visible on radiography are
generally considered to have spasm of the cricopharyngeus, which is the
major muscle component of the upper esophageal sphincter. This condition has
been termed "cricopharyngeal achalasia".  The aim of this study was to
determine the pathogenesis of cricopharyngeal bars. Concurrent
videofluoroscopic and manometric examinations of the pharynx and upper
esophageal sphincter were performed in a cohort of six patients with
prominent cricopharyngeal bars and in eight control volunteers. In each
subject, swallows of 2-30-mL barium boluses were recorded. The patients with
cricopharyngeal bars showed (a) normal peristaltic contraction in the
pharynx, (b) normal axial upper esophageal sphincter pressure and
relaxation, (c) normal flow rate across the upper esophageal sphincter, and
(d) normal duration of upper esophageal sphincter opening for different
bolus volumes. The major abnormalities in the patients with cricopharyngeal
bars were (a) reduced maximal dimensions of the upper esophageal sphincter
during the transsphincteric flow of barium and (b) increased intrabolus
pressure upstream to the upper esophageal sphincter. Thus, the increase in
intrabolus pressure preserved normal transsphincteric flow rates even though
the upper esophageal sphincter did not open normally. Overall, the
constellation of findings in the patients studied suggests that the
underlying pathogenesis of their cricopharyngeal bar was reduced muscle
compliance wherein the relaxed cricopharyngeus did not distend normally
during swallowing.

This would seem to imply that resistance within the muscles of the CP (slow
twitch fiber muscles, mainly) prevent the mechanical stretching required by
the hyoid attachments and/or did not distend following applied pressure of
the bolus.
Comments?
Irene.

----- Original Message -----
From: Phyllis Palmer <ppalmer@medonline.com>
To: Larry/Pam Seibert <lpseibert@home.com>
Cc: <dysphagia@medonline.com>
Sent: Sunday, March 11, 2001 12:22 AM
Subject: Re: [DYSPHAGIA] cricopharyngeal spasms


> Pam,
>
> Opening of the UES is accomplished by passive stretch due to hyolaryngeal
> elevation, widening from intrabolus pressure, and relaxation of the CP
> muscle. I would want to know more about what he saw at teh level of the
> UES and what led him to diagnose a spasm. Did he do EMG durign swallowing
> to not CP relaxation patterns? While I am sure the answer is no, I say
> this because I am not certain that you can tell the CP is spasming from
> susopending a scope in the pharynx (at least I can't)...you guys who do
> lots of scoping, what is your experience with being able to identify
> dysfunction of the CP muscle within the UES.
>
> If the problem is related to CP relaxation then some docs may consider
> botox or bougie before they consider myotomy. If the issue is relatred to
> either of the other 2 components of the UES opening, you have some rx
> techniques you can try,
>
> Woudl love to hear how others deal with prominent CP muscles...or what
> folks do when they see a CP bar on video?
>
> Phyllis
>
>
> On Thu, 8 Mar 2001, Larry/Pam Seibert wrote:
>
> > Am scheduled to see a quadraplegic tomorrow who is on a cuffless trach
> > and was recently scoped because he started having trouble swallowing
> > solids.  He complained that there was difficulty at the level of the
> > trach.  He was on a regular diet for years prior to this.
> >
> > When scoped the physician ordered 2 months of speech therapy to
> > strengthen the swallow before considering a myotomy.  A spasm was noted
> > at the level of the cricophayngus.
> >
> > I haven't done much of this before and would appreciate anyone's advice
> > on such a case.
> >
> > Pam
> >
> > ---------------------------------------------------------------------
> > To UNSUBSCRIBE from this list, please send an e-mail message to
> > majordomo@medonline.com with the following text as a message:
> > unsubscribe dysphagia
> > ---------------------------------------------------------------------
> >
>
> --
> __________________________________________________________
> Phyllis M. Palmer, Ph.D.       Speech Language Pathologist
>                www. dysphagia.com
> __________________________________________________________
>
> ---------------------------------------------------------------------
> To UNSUBSCRIBE from this list, please send an e-mail message to
> majordomo@medonline.com with the following text as a message:
> unsubscribe dysphagia
> ---------------------------------------------------------------------

---------------------------------------------------------------------
To UNSUBSCRIBE from this list, please send an e-mail message to
majordomo@medonline.com with the following text as a message:
unsubscribe dysphagia
---------------------------------------------------------------------