Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, L69 3BX, Liverpool, UK.
ENT Department, University of Padova, Via 8 Febbraio 1848, 2, 35122, Padova, PD, Italy.
Neurol Sci. 2020 Nov;41(11):3067-3073. doi: 10.1007/s10072-020-04495-2. Epub 2020 Jun 7.
Dysphagia is defined as an impairment of this complex and integrated sensorimotor system. It is estimated that 400,000 to 800,000 individuals worldwide develop neurogenic dysphagia per year. Neurogenic dysphagia is typically occurring in patients with neurological disease of different etiologies. A correct and early diagnosis and an appropriate management of dysphagia could be useful for improving patient's quality of life and may help to prevent or delay death. In the present review, we discuss thoroughly the anatomy and physiology of swallowing and also the pathophysiological mechanisms involved in impaired swallowing, as well as the diagnosis, management, and potential treatments of neurogenic dysphagia. Assessment of neurogenic dysphagia includes medical history, physical exam, and instrumental examinations (fiberoptic endoscopic evaluation of swallowing, videofluoroscopic swallowing study, electromyography). Pharmacological treatment of these problems includes oral anticholinergic drugs. Surgical myotomy of the cricopharyngeal muscle showed an important improvement of oropharyngeal dysphagia associated to upper esophageal sphincter hyperactivity. Chemical myotomy of the upper esophageal sphincter by local injections of botulinum toxin type A into the cricopharyngeal muscle has been proposed as an alternative less invasive and less unsafe than surgical myotomy.
吞咽障碍是指这个复杂且整合的感觉运动系统出现了损伤。据估计，全世界每年有 40 万至 80 万人患有神经性吞咽障碍。神经性吞咽障碍通常发生在病因不同的神经疾病患者中。正确和早期的诊断以及对吞咽障碍的适当管理有助于提高患者的生活质量，并可能有助于预防或延迟死亡。在本次综述中，我们深入讨论了吞咽的解剖学和生理学，以及吞咽障碍涉及的病理生理机制，以及神经性吞咽障碍的诊断、管理和潜在治疗方法。神经性吞咽障碍的评估包括病史、体格检查和仪器检查（纤维内镜吞咽评估、视频透视吞咽研究、肌电图）。这些问题的药物治疗包括口服抗胆碱能药物。环咽肌肌切开术治疗上食管括约肌过度活动相关的口咽吞咽障碍显示出重要的改善。通过向环咽肌局部注射肉毒毒素 A 进行上食管括约肌化学肌切开术，已被提出作为一种替代方法，与手术肌切开术相比，其创伤更小、安全性更高。
