Dysfunction of the pharyngo-oesophageal segment in patients with normal opening of the upper oesophageal sphincter: a cineradiographic study.

Abnormal opening of the upper oesophageal sphincter, i.e. abnormal relaxation of the cricopharyngeal muscle, is common in dysphagic patients. It is often present together with other motor abnormalities in the pharyngo-oesophageal (PO) segment, such as defective tonicity, relaxation and peristalsis. However, such PO motor dysfunction was demonstrated in 22 dysphagic patients who had normal relaxation of the cricopharyngeal muscle. Ten had defective peristalsis in the segment cranial to the cricopharyngeus. In eight of these, barium contrast medium was retained at the end of the bolus passage. In one patient the cricopharyngeal muscle contracted too early ahead of the peristalsis. In four patients peristalsis and tonus were defective within the cervical oesophagus. In 145 non-dysphagic volunteers, with normal relaxation of the cricopharyngeal muscle, there was no such motor dysfunction in the PO segment. Our observations indicate that motor function of the PO segment is normally synchronous and symmetrical. Motor dysfunction within the PO segment is rare but is detectable with a cineradiographic technique. In the absence of other morphological and functional abnormalities within the pharynx proper, it is probable that these motor dysfunctions in a dysphagic patient may have importance for the development of symptoms.