cyclopharyngeal achalasia
Introduction
Introduction to pharyngeal muscle achalasia The pharynx is composed of the upper esophageal sphincter (UESM), the pharyngeal muscle, the pharyngeal muscle, the upper esophageal ring muscle, and the hypopharyngeal and cartilage of the cartilage. The sensation and movement of the UESM and the pharyngeal muscle are governed by the sensory fibers of the glossopharyngeal nerve and the voluntary motor fibers of the vagus nerve. So swallowing can begin as desired, or it can be caused reflexively by oropharyngeal irritation. At rest, the UESM is in a state of tension. When swallowing, the food is strongly contracted through the mouth, the tongue muscles, the pharyngeal muscles, etc., pushing the bolus to the pharynx, the UESM is relaxed, and the bolus is contracted immediately after entering the esophagus. This process is about 0.3s. (0.13~0.63s), after the swallowing movement, the esophageal body produces a peristaltic contraction and pushes it into the stomach after 0.5~1s, then closes. Therefore, the swallowing movement is the hypopharynx, UESM, and esophageal body. The result of synergy with relaxation and contraction of the lower esophageal sphincter (LESM). If swallowing is inconsistent with swollen during swallowing, the bolus can hardly enter the esophagus from the pharynx, causing difficulty in swallowing, that is, circulatory achalasia, also known as esophageal fistula. basic knowledge Sickness ratio: 0.0001% Susceptible people: good for middle-aged women Mode of infection: non-infectious complication:
Cause
Cause of pharyngeal achalasia
(1) Causes of the disease
The dysfunction of the pharyngeal muscle group can be caused by degeneration of nerves or muscles.
1. Neuromuscular diseases Patients with cerebrovascular accidents may have language disorders and facial expression disorders. Conjunctival disorders may be accompanied by inconsistencies in the activities of the upper esophageal sphincter muscle (UESM), and the formation and promotion of bolus formation. Difficulties, amyotrophic lateral sclerosis due to loss of motor neurons and control functions, can occur random swallowing disappearance, linguistic disorder and repeated aspiration, Riley-Day syndrome (Riley-Day Syndrome) is a congenital familial autonomic dysfunction characterized by straight sterling hypotension, low sweating, bladder and sexual dysfunction. Such patients have abnormalities in the chemical or mechanical receptors of the respiratory center, so breathing difficulties often occur. The arterial oxygen saturation (SaO2) is significantly reduced, and there is a simultaneous hypopharyngeal disorder. Huntingtons chorea is an senile neurological disease characterized by involuntary continuous movements in various parts of the body. The pharynx is characterized by hypopharyngeal dysfunction, and patients with Parkinsons disease are slow to form a bolus, starting under There is often a delay in the pharynx, progressive systemic sclerosis is a connective tissue disease, 50% of these patients are involved in esophageal function, Colman (1999) reported a group of 36 patients with this disease for esophageal motor function test It was found that 33 of them had esophageal motor dysfunction.
2. Myogenic diseases The skeletal muscle of the pharyngeal medullary myasthenia gravis, UESM and 1/4 above the esophagus are often involved, causing a special difficulty in swallowing, often accompanied by coughing, coughing and food reflux into the nasal cavity. This phenomenon is not due to obstruction of the pharyngeal muscle or the inability to relax, but the weakness of the muscles due to weakness of the soft diaphragm muscles, so that the nasopharyngeal part can not be completely blocked when swallowing (Wright, 2000), muscular dystrophy (muscular dystrophy) Unexplained, can cause pharyngeal skeletal muscle and esophageal muscle degeneration, its motor function is affected, patients may have difficulty in dysphagia, oculopharyngeal muscular dystrophy (oculopharyngeal muscular dystrophy) is a rare In the elderly, the main symptoms are difficulty in hypopharyngeal and progressive drooping of the eyelids. Duranceau et al. (1980) reported that 11 patients were treated with UESM incision, 8 patients had good results, and the other 3 patients had different degrees of improvement.
3. Structural changes idiopathic dysfunction of UESM is a dysfunction of UESM itself. For some patients with oropharyngeal dysphagia, those who cannot explain neurological or muscular diseases should consider this situation. Possibly, the patient is mostly nervous. It is not possible to provide a clear neuropsychological explanation as the basis of the disease. The main manifestations are difficulty in swallowing of the oropharynx, frequent blockage of food and multiple aspirations. There is difficulty in swallowing, the reason may be poor coordination of UESM, sputum, loss of relaxation or just due to the lack of relaxation of UESM. In addition to diverticulectomy, it should be added as UESM incision, due to the structure involved in swallowing. It is very complicated, so hypopharyngeal dysfunction may occur after laryngectomy or other throat surgery. Gastroesophageal reflux can be the cause of UESM dysfunction (Henderson, 1976). When the reflux reaches the UESM plane, it can cause secondary UESM.
(two) pathogenesis
When the UESM contractes, the peristalsis of the esophagus begins. If a certain factor causes the swallowing activity to be uncoordinated, or the pharyngeal muscle contraction is invalid, the UESM may not completely relax or relax in advance, and dysphagia may occur.
Prevention
Cyclopharyngeal achalasia prevention
1. Develop good habits, stop smoking and limit alcohol. Smoking, the World Health Organization predicts that if people no longer smoke, after five years, the world's cancer will be reduced by 1/3; secondly, no alcohol. Smoke and alcohol are extremely acidic and acidic substances. People who smoke and drink for a long time can easily lead to acidic body.
2. Don't eat too much salty and spicy food, don't eat food that is overheated, too cold, expired and deteriorated; those who are frail or have certain genetic diseases should eat some anti-cancer foods and high alkali content as appropriate. Alkaline foods maintain a good mental state.
Complication
Cycloparyngeal achalasia complications Complication
The peristalsis of the esophagus begins when the UESM contracts. If a factor causes inconsistency in swallowing activity, or if the pharyngeal muscle contraction is ineffective, the UESM may not fully relax or relax in advance, and dysphagia may occur. Gastroesophageal reflux can be a cause of dysfunction of UESM (Henderson, 1976). When the reflux reaches the UESM plane, it can cause secondary UESM.
Symptom
Cycloparyngeal achalasia symptoms Common symptoms swallowing pain anxiety cough food swallowing neck... gas over water sore throat dysphagia
It occurs mostly in middle-aged and elderly women. It is more common in people with impatience or anxiety. The patient complains that it is difficult to swallow when eating. The food stays in the oropharynx and cannot enter the esophagus. Therefore, the meal time is greatly prolonged. If it is liquid, it is swallowed. After being mistakenly inhaled into the respiratory tract, causing cough, and swallowing pain, blockage, foreign body sensation, or the sound of water in the neck when the food swallowed, the weight decreased.
Examine
Cycloparyngeal achalasia
1. Radiological examination For patients with oropharyngeal dysphagia, multi-stage, multi-position fluoroscopy and TV scanning are required. Due to the rapid activities of various links during swallowing, only these techniques can be used to accurately record, such as the movement of the tongue. The activity of the soft palate, the symmetry of the pharyngeal contraction, the activity of the larynx, and the activity of the UESM in the resting state, etc., when the esophageal angiography is performed in patients with idiopathic UESM dysfunction, the UESM plane has a common esophagus. The cricopharyngeal bar, called the pharyngeal phlegm (Fig. 1), is found in 5% of normal people.
2. The radionuclide emptying test can easily monitor the emptying function of the oropharynx. In various patients with oropharyngeal dysphagia, the use of liquid or solid bolus can quantify the emptying function (Fig. 2).
3. Motor function detection For the physiological function detection of UESM, two important factors must be considered: one is the asymmetry of the radioactivity and its axiality of the sphincter fiber arrangement, and the other is the movement of the sphincter in the forward and upward direction during swallowing. Single-hole pressure conduits are less accurate in detecting UESM resting pressure. Multi-cavity pressure conduits have their own orifices on the same plane, which can accurately record the pressure of UESM everywhere at rest. Pressure sensors provide the most accurate pressure data (Castell, 1990).
Neurogenic oropharyngeal motor dysfunction is characterized by UESM resting pressure abnormalities, inconsistency and relaxation disorders (Fig. 3), and the pharyngeal contractility of patients with myogenic oropharyngeal hypopharyngeal dysfunction is weak and lasts longer. Its contractile force is not sufficient to push the bolus through the UESM, making the UESM an obstacle to food advancement (Figure 4).
Cook et al (1992) and Jamieson et al (1994) conducted an in-depth study of the structural disorders of the UESM dysfunction and the pharyngeal esophageal diverticulum that could not be explained by neurological and myogenic diseases. They found that during the swallowing process, the pharyngeal esophageal diverticulum The patient's UESM is often closed early and in a state of continuous contraction (Fig. 5), and the pressure in the lower pharyngeal group is significantly increased (Fig. 6). At the same time, they measured the maximum area of the sphincter after opening and found the patient. The sphincter area is significantly smaller than normal.
Recent work has found that the UESM in patients with Zenker's diverticulum has multiple histological signs of localized myopathy, such as tissue fibrosis and sphincter inflammation, indicating that the formation of Zenker's diverticulum is a decrease in UESM compliance and an increase in pressure in the lower pharyngeal bolus. In the absence of anatomical relaxation, UESM is the result of strong resistance for a long period of time with high resistance.
4. Imaging examination
(1) Examination method: dynamic imaging of the pharynx, ie, barium meal imaging, X-ray video (movie), digital image or quick dot film, etc. to track the pharyngeal activity during swallowing, and the barium meal inspection adopts the erect side Position, erect left front or right front 30° oblique position and lying position E- long sound or Valsalva action; record the sputum emptying of the epiglottic and pear-shaped fossa, contrast contrast agent concentration requirement 150%250% (W/V), solid tinctures of different shapes and sizes, tinctures mixed with food such as bread balls, glutinous rice, etc., about 15 to 20 ml swallowed once, and required to be swallowed as much as possible once.
(2) Image characteristics: 1 swallowing delay: the time of the pharyngeal agent through the pharynx is prolonged; 2 small amount of swallowing: the patient can not swallow the mouth, and must swallow multiple times to swallow all the sputum in the mouth (Fig. 7); Symmetrical swallowing: after swallowing, both sides will be disgusted, the pear-shaped nest is asymmetrical, or one side is irregular; 4 throat retention: after swallowing, the pharynx still retains a large amount of tincture, which is Y-shaped; 5 sputum spill: The agent leaked into the trachea with swallowing action, the pharynx was relaxed, and the epiglottis was in a relaxed state (Fig. 8, 9). 6 Structural abnormalities: if the epiglottis was elongated, the pharynx appeared diverticulum, cysts, etc., the esophagus abnormally contracted and reversed. Flow and so on.
Diagnosis
Diagnosis and diagnosis of cycloparyngeal achalasia
1. Older women with a history of cerebrovascular disease, or with central nervous system diseases and muscle degenerative diseases, or a family history of Riley-Dai syndrome.
2. Clinical manifestations: swallowing pain, obstruction, foreign body sensation, difficulty in swallowing, prolonged meal time; drinking liquid is easy to cause cough, and the neck has a feeling of gas over water when the food is swallowed.
3. Auxiliary examination of barium meal angiography showed dilatation of esophagus, poor swallowing, pharyngeal spasm discharge, etc., pharyngeal dynamic angiography showed that the row empty time was greatly prolonged, motor function detection UESM resting pressure abnormality, uncoordinated and relaxation disorder.
