ANALYSIS OF THE PHARYNGOESOPHAGEAL PRESSURE PROFILE IN AMYOTROPHIC-LATERAL-SCLEROSIS

Treatment of dysphagia resulting from bulbar amyotrophic lateral scler osis has included cricopharyngeal myotomy for many years but is succes sful in only a minority of cases. The purpose of this study was to exp lore the rationale for this procedure with modern manometric technique s. The results of pharyngoesophageal manometry in 13 patients with amy otrophic lateral sclerosis were compared with 13 age- and sex-matched healthy volunteers by Mann-Whitney analysis. There was no significant difference between patients and control subjects in distal esophageal or lower esophageal sphincter motility nor any pressure parameter of p haryngoesophageal motility. Separate analysis of the seven significant ly dysphagic subjects showed a significantly reduced upper esophageal sphincter after-contraction amplitude during water and bread swallows in patients than in control subjects, These data suggest that the dysp hagia of amyotrophic lateral sclerosis is not due to upper esophageal sphincter spasm and that treatment by cricopharyngeal myotomy may be i nappropriate.