CRICOPHARYNGEAL DYSFUNCTION IN A PATIENT WITH ACHALASIA

A 64-year-old man had intense dysphagia and aspiration of 1 month's du ration. The patient had lower esophageal sphincter (LES) achalasia and cricopharyngeal dysfunction, with generalized muscle weakness discove red by neurologic examination. Endoscopy showed no lesions of the mout h, pharynx, larynx, or esophagus. The diagnosis of achalasia was made by manometry. The LES did not relax with deglutition; the contractions in the esophageal body were nonperistaltic and of low amplitude; and the upper esophageal sphincter pressure did not decrease after degluti tion. A scintigraphic study of the oral and pharyngeal phases of swall owing showed a mouth and pharyngeal retention of 90% of the volume swa llowed.