What is the pathophysiology of dysphagia in esophageal-phase disorders?

Updated: Mar 20, 2020
  • Author: Nam-Jong Paik, MD, PhD; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Impaired esophageal function can result in retention of food and liquid in the esophagus after swallowing. This retention may result from a mechanical obstruction, a motility disorder, or an impairment of the opening of the lower esophageal sphincter.

Achalasia can lead to reduced gastroesophageal junction relaxation or absent esophageal peristalsis.

Logemann's Manual for the Videofluorographic Study of Swallowing cites the following swallowing symptoms and disorders of the esophageal phase [11] :

  • Esophageal-to-pharyngeal backflow due to esophageal abnormality

  • Tracheoesophageal fistula

  • Zenker diverticulum

  • Reflux

Zenker diverticulum can lead to swallowing difficulty, with possible nocturnal aspiration of residue in the diverticulum.

Other defects in the wall of the esophagus or in the external structures (eg, in the hilar lymph nodes) can lead to dysfunction in the propulsion of the bolus from the esophagus to the stomach (eg, esophageal webs, rings, strictures; intraluminal obstruction from solids) and result in weak esophagopharyngeal peristalsis due to scleroderma or other conditions.

A study by Kawaguchi et al determined that primary esophageal motility disorder was present in 58 out of 100 study patients with dysphagia, indicating that it has a not uncommon association with swallowing difficulties. [13]

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