SWALLOWING DISORDERS

Dysphagia is related to the impairment of food passage from the mouth to the stomach.Globus pharyngis implies the frequent and often painful sensation of a lump in the throat that usually does not interfere wit h swallowing and may even be relieved by food intake. The diagnosis is based upon a careful history, clinical examination, endoscopy, dynami c imaging (videofluoroscopy, cinematography, videosonography) and elec trophysiologic procedures (including pharyngoesophageal manometry, ele ctromyography and pH determinations). Structural lesions of the cervic al spine such as diffuse idiopathic skeletal hyperostosis are rare cau ses of dysphagia. Dysphagia following anterior cervical fusion as well as globus and dysphonia due to dysfunction of the vertebral joints ar e more likely. Symptoms with swallowing fluids indicate a neurogenic o rigin. Dyscoordinated swallowing, nasal reflux, dysphonia or general w eakness may also occur. Chronic aspiration with respiratory compromize is the main consequence in a variety of neurological disorders as wel l as in cases of postsurgical dysphagia. Relaxation of the upper esoph ageal sphincter indicates coordinated muscle movement between the phar ynx and esophagus. Dysfunction of the pharyngoesophageal segment may l ead to cricopharyngeal achalasia. A dyskinetic sphincter commonly repr esents an extra-pharyngeal cause: i.e., disease associated with gastro esophageal reflux. Disorders of the esophageal phase of deglutition ca n produce retrosternal pain,heartburn,regurgitation and vomiting, as w ell as laryngeal and respiratory signs. Esophageal motility disorders include lower achalasia,tumors, peptic strictures, inflammatory diseas es, drug-induced ulcers, rings and webs. Motility disorders present wi th aperistaltic, spontaneous contractions,diffuse esophagospasm, or a hypermotile esophagus. Gastroesophageal reflux with esophagitis must a lways be excluded, especially in patients with a globus sensation. The multiple features of the appearance of the symptoms of dysphagia and globus makes multidisciplinary approach necessary in order to establis h a diagnosis and begin effective treatment.