[Dysphagia] esophageal dysphagia

[pressmah at sjhmc.org (Pressman, Hilda)]

Just go on the ASHA website and search for the info

-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com]On
Behalf Of melody sheldon
Sent: Saturday, July 08, 2006 3:34 PM
To: dysphagia@b9.com
Subject: [Dysphagia] esophageal dysphagia


>> I would like a copy of the portion of the ASHA document Dr. Butler 
>> mentioned regarding our responsibility for evaluation  of the upper 
>> portion of the esophagus.

thank you in advance
msheldon@uci.net
>> The following references are great (from the Radiology and GI 
>> literature-
>> all MD's) for educating others re: the importance of evaluating the
>> cervical
>> esophagus *and* performing an esophageal screening during evaluation 
>> of
>> the
>> oropharynx.  Additionally, Medicare holds us responsible for 
>> evaluating
>> the
>> upper 1/3 (i.e. cervical esophagus) during the MBS.  I tried 
>> attaching the
>> portion of the ASHA document Dr. Butler mentioned...(Hi Susan!!!), 
>> but it
>> was too large, if anyone wants me to send them it directly, let me 
>> know.
>> Julie Huffman
>>
>> 1.      Oropharyngeal and esophageal interrelationships in patients 
>> with
>> nonobstructive  dysphagia.
>>
>>
>>
>> Triadafilopoulus, G; Hallstone, A; Nelson-Abbott, H; Bedinger, K.
>> Digestive Diseases & Sciences.  37(4):551-7, 1992 Apr.  (Dig Dis Sci.
>> 37(4):551-7, 1992 Apr.)
>>
>>
>> Normal swallowing requires the close functional coordination of the 
>> mouth,
>> pharynx, and esophagus, and if one of these components becomes
>> functionally
>> impaired, it is likely that the others may be affected. Using
>> videofluoroscopy and manometry in this study, we examined the 
>> esophageal
>> phase of swallowing in 12 patients with oropharyngeal dysphagia 
>> (group A)
>> and the oropharyngeal components of swallowing in 29 patients with
>> esophageal motor dysfunction and nonobstructive dysphagia (group B). A
>> wide
>> range of esophageal function abnormalities was seen in the first 
>> group,
>> including delayed esophageal body peristalsis, spontaneous or 
>> simultaneous
>> (tertiary) contractions, esophageal body dilation, proximal bolus
>> redirection, and poor lower esophageal sphincter relaxation.
>> Manometrically,
>> 92% of group A patients were classified as having nonspecific 
>> esophageal
>> motility disorder (NSEMD). In a similar fashion, group B patients
>> exhibited
>> many oropharyngeal function abnormalities on videofluorography 
>> including
>> disturbed lingual peristalsis, slowed pharyngeal transit time with 
>> poor
>> constriction of pharyngeal muscles, and laryngeal vestibular and 
>> tracheal
>> bolus penetration. Manometrically, group B patients were classified as
>> having NSEMD, achalasia, diffuse esophageal spasm, nutcracker 
>> esophagus,
>> scleroderma, and chronic intestinal pseudoobstruction. In conclusion,
>> oropharyngeal function is significantly altered in patients with
>> esophageal
>> motility disorders and dysphagia, and esophageal motor dysfunction 
>> occurs
>> in
>> patients with oropharyngeal dysphagia. These changes may represent 
>> either
>> a
>> compensatory mechanism or concomitant involvement of the oropharynx 
>> or the
>> esophagus by the underlying neuromotor disorder. We suggest that
>> assessment
>> by esophageal motility and videofluoroscopy of both the oropharyngeal 
>> and
>> esophageal phases of swallowing may improve diagnosis and therapy in
>> patients with nonobstructive dysphagia
>>
>>
>>
>> 2.      Pharyngoesophageal interrelationships: observations and 
>> working
>> concepts.
>>
>>
>>
>> Jones, B; Ravich, WJ; Donner, MW; Kramer, SS; Hendrix, TR.
>>
>> Gastrointest Radiol 1985; 10 (3): 225-33  (ISSN: 0363-2345)
>>
>>
>>
>> Simultaneous disorders of the pharynx and esophagus are so frequent 
>> that
>> the
>> complete swallowing chain should be examined in all patients with
>> dysphagia.
>> Data are presented to support the concept that such simultaneous 
>> disorders
>> represent related phenomena; the mechanism involves changes in the
>> cricopharyngeal function seen radiographically as cricopharyngeal
>> prominence.  If neurologic disease has been excluded, cricopharyngeal
>> prominence may be the clue to esophageal disease.  When 
>> cricopharyngeal
>> prominence is found during dynamic imaging of the pharynx, intensive
>> examination of the esophagus and a search for signs of compensation or
>> decompensation in the pharynx should be undertaken.
>>
>>
>>
>> 3.      Dynamic Imaging of the Pharynx
>>
>>
>>
>> Jones B, Kramer SS, Donner MW
>>
>> Gastrointest Radiol (United States), 1985, 10(3) p213-24
>>
>>
>>
>> The technique of dynamic imaging of the pharynx and some supplementary
>> maneuvers which can be tailored to the individual patient's needs are
>> discussed in detail. An approach to the analysis of normal and 
>> abnormal
>> swallowing studies is presented.
>>
>>
>>
>> 4.  The Swallowing Center: concepts and procedures.
>>
>> Ravich WJ, Donner MW, Kashima H, Buchholz DW, Marsh BR, Hendrix TR, 
>> Kramer
>> SS, Jones B, Bosma JF, Siebens AA, et al.
>> Gastrointest Radiol. 1985;10(3):255-61
>> This paper describes the purpose and organization of a dedicated 
>> center at
>> The Johns Hopkins Medical Institutions for the evaluation of 
>> swallowing
>> problems. The multidisciplinary approach outlined will permit a better
>> understanding and more accurate diagnosis of the functional or organic
>> lesions affecting the swallowing mechanisms. Illustrative cases are
>> presented.
>>
>>
>>
>> ----- Original Message ----- From: <SPalm1532@aol.com>
>> To: <dysphagia@b9.com>
>> Sent: Thursday, June 22, 2006 7:15 PM
>> Subject: [Dysphagia] Re: Dysphagia Digest, Vol 31, Issue 17 esophageal
>> dysphagia
>>
>>
>>>
>>> Does anyone have any specific M.D. references regarding the 
>>> parameters
>>> for
>>> assessment of the cervical esophagus during an MBS . The ACR 
>>> guidelines
>>> do
>>> not
>>> address this. Many of our radiologists are firmly against addressing 
>>> even
>>> the cricopharyngeus much less cervical esophagus- stating that is a
>>> different
>>> test and  that doing so would result in a "sub-optimal" test. . In
>>> addition
>>> there is increasing resistance to doing A-P projections (too much
>>> radiation),
>>> multiple trials, etc. Did something happen that we missed? Any input
>>> would be
>>> appreciated.
>>> _______________________________________________
>>> Dysphagia mailing list
>>> Dysphagia@b9.com
>>> http://lists.b9.com/mailman/listinfo/dysphagia
>>

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