PHARYNGOESOPHAGEAL DYSPHAGIA - SURGERY BASED ON CLINICAL AND MANOMETRIC DATA

High or pharyngo oesophageal dysphagia (PD) is defined as difficulty i n initiating the act of swallowing within Is. It involves the mechanis ms controlling the tongue, pharynx and upper oesophageal sphincter (UO S) and is associated with a wide variety of local, neurologic and musc ular disorders, and can also occur after surgery in the area and in re sponse to gastrooesophageal reflux (GOR). Our study aims at defining t he criteria for surgery in PD and to evaluate the clinical results of such treatment. Twenty-three patients who underwent surgery were evalu ated with pharyngo-oesophageal motility and ambulatory 24-hr pH-metry. The following parameters were measured: 1) pharyngeal contraction amp litude, 2) duration, 3) repetitive pharyngeal contractions, 4) UOS ton e, 5) percentage of UOS relaxation, 6) duration of relaxation, 7) UOS closing pressure, 8) UOS closing duration, 9) co-ordination of UOS clo sing pressure and upper oesophageal (UO) contractions. Preoperative ma nometry showed a variety of abnormalities in several of the parameters , such as prolonged pharyngeal contraction (''spasm''), unco-ordinated pharyngeal contractions and UOS relaxation, low amplitude pharyngeal contractions, unco-ordinated UOS closing tone and UO contractions and hypotonic UO. Surgery was directed at the specific abnormality in each patient taking into consideration the presence or absence of GOR. Sev enteen patients (74%) had excellent results. Three other patients (13% ), who had improved swallowing but who continued to have GOR complicat ed by some oesophageal dysmotility, oesophagitis and an oesophageal we b, underwent subsequent anti-reflux surgery with relief of symptoms. I n conclusion, pharyngo-oesophageal motility measurement is mandatory i n PD, especially when a diverticulum is absent. Cricopharyngeal myotom y with or without diverticulectomy as indicated produces excellent res ults. Associated oesophageal problems have to be dealt with appropriat ely.