Solt J, Bajor J, Moizs M, Grexa E
I. Belgyógyászati Osztály, Baranya Megyei Kórház, Pécs.
Orv Hetil. 2000 Oct 15;141(42):2287-92.
The primary cricopharyngealis achalasia (PCA) is a very uncommon functional disorder of the upper oesophageal sphincter (UES) characterized by dysphagia, frequent aspiration, and impaired relaxation of the UES. It should be differentiated from diseases of neuromuscular and ENT origin, from organic causes and other types of cricopharyngeal dysfunction. On suspected oesophageal inlet stenosis, swallow x-ray studies using water-soluble contrast material is performed, followed by oesophagoscopy. If the endoscope cannot pass into the oesophagus, balloon dilatation is performed to reach a diameter of 12-15 mm. This facilitates the passing of the endoscope and helps ruling out organic causes. If the stenotic segment dilates easily, the mucosa is intact, and no mechanical obstruction is discovered, then UES manometry is performed to differentiate from other motility disorders. Extraluminal causes are excluded using endosonography and CT. If PCA is diagnosed, low-pressure (1-1.5 atm) balloon dilatation is continued under fluoroscopic control until a lumen diameter of 18-20 mm is obtained. Efficacy of dilatation is assured clinically as well as with endoscopical, barium swallow and manometric studies. Five out of 28 patients with pharyngo-oesophageal dysphagia were found to have PCA. Patients presented with severe dysphagia and a predisposition to aspiration. The radiographic examination demonstrated stenosis at the UES level, and aspiration. It was possible to introduce the endoscope into the oesophagus only two of the five patients before the dilatation. The manometry was not pathognomonic, its value did not achieve the expectations. In contrast with organic stenoses, UES dilated easily using balloon catheter. Thereafter, the endoscope passed smoothly through the UES in each of cases. Following progressive dilatation--with low pressure (1.5-2 atm) up to 20 mm in diameter-, superficial mucosal damage was observed in one patient only. Patients' complaints ceased after treatment, and the barium swallow showed normal passage. Redilatation was necessary only in one case after following 21 (7-33) months. The authors supposed that the gastrooesophageal reflux plays role in the pathogenesis of PCA. Balloon catheter dilatation is an important diagnostic and at the same time effective, first choice, minimal invasive therapeutic method in PCA.
原发性环咽肌失弛缓症（PCA）是一种非常罕见的食管上括约肌（UES）功能障碍性疾病，其特征为吞咽困难、频繁误吸以及UES松弛受损。应将其与神经肌肉源性和耳鼻喉源性疾病、器质性病因以及其他类型的环咽肌功能障碍相鉴别。怀疑食管入口狭窄时，使用水溶性造影剂进行吞咽X线检查，随后进行食管镜检查。如果内镜无法进入食管，则进行球囊扩张，使其直径达到12 - 15毫米。这有助于内镜通过，并有助于排除器质性病因。如果狭窄段容易扩张，黏膜完整，且未发现机械性梗阻，则进行UES测压以与其他动力障碍相鉴别。使用超声内镜和CT排除腔外病因。如果诊断为PCA，则在荧光透视控制下继续进行低压（1 - 1.5个大气压）球囊扩张，直至管腔直径达到18 - 20毫米。通过临床以及内镜、吞钡和测压研究确保扩张效果。28例咽食管吞咽困难患者中有5例被发现患有PCA。患者表现为严重吞咽困难并有误吸倾向。影像学检查显示UES水平狭窄及误吸。扩张前5例患者中只有2例能够将内镜插入食管。测压结果不具有特异性，其价值未达预期。与器质性狭窄不同，使用球囊导管很容易使UES扩张。此后，每例患者的内镜均顺利通过UES。在进行直径达20毫米的低压（1.5 - 2个大气压）逐步扩张后，仅1例患者出现浅表黏膜损伤。治疗后患者的症状消失，吞钡显示通过正常。随访21（7 - 33）个月后仅1例患者需要再次扩张。作者推测胃食管反流在PCA的发病机制中起作用。球囊导管扩张是PCA重要的诊断方法，同时也是有效、首选的微创治疗方法。
