Ogawa Mika, Kenjiro Kunieda, Ohno Tomohisa, Okamoto Keishi, Fujishima Ichiro
Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, JPN.
Department of Neurology, Gifu University Graduate School of Medicine, Gifu, JPN.
Cureus. 2024 Jun 11;16(6):e62191. doi: 10.7759/cureus.62191. eCollection 2024 Jun.
Balloon dilation therapy (BDT) is used to treat pharyngeal dysphagia in patients with impaired upper esophageal sphincter (UES) relaxation due to cricopharyngeal dysfunction. However, the mechanism underlying this immediate effect remains unclear. Here, we present a case in which we investigated the immediate effects of BDT on UES dysfunction using high-resolution manometry (HRM). A 67-year-old man was diagnosed with spinal muscular atrophy (SMA). He gradually developed dysphagia, and a gastrostomy was performed. Despite continuing oral intake of supplemental nutrition, the patient developed dysphagia. Videofluoroscopic (VF) examination of swallowing revealed pharyngeal residue, while HRM showed weak pharyngeal contractility and impaired UES opening. BDT was performed to address the UES dysfunction. Immediately following BDT, VF demonstrated improved pharyngeal bolus passage. As for the UES function during swallowing, HRM revealed that the UES relaxation duration was significantly longer and the UES nadir pressure was significantly decreased. The patient continued the BDT before oral intake. HRM revealed immediate and prolonged UES opening with decreased UES pressure during swallowing as an immediate effect of BDT. This suggests that these findings represent the mechanisms underlying dysphagia in this patient with SMA. BDT resulted in an immediate improvement in UES function, potentially leading to dysphagia improvement. BDT should be combined with conventional rehabilitation for impaired UES opening. However, further studies are needed to confirm the long-term effectiveness of BDT for dysphagia due to SMA.
球囊扩张治疗（BDT）用于治疗因环咽肌功能障碍导致食管上括约肌（UES）松弛受损的患者的咽吞咽困难。然而，这种即时效应的潜在机制仍不清楚。在此，我们报告一例使用高分辨率测压法（HRM）研究BDT对UES功能障碍即时效应的病例。一名67岁男性被诊断为脊髓性肌萎缩症（SMA）。他逐渐出现吞咽困难，并接受了胃造瘘术。尽管持续经口摄入补充营养，但患者仍出现吞咽困难。吞咽的视频荧光透视（VF）检查显示咽部有残留物，而HRM显示咽部收缩力弱且UES开放受损。进行BDT以解决UES功能障碍。BDT后立即进行的VF显示咽部团块通过情况有所改善。至于吞咽过程中的UES功能，HRM显示UES松弛持续时间明显延长，UES最低点压力明显降低。患者在经口进食前继续接受BDT治疗。HRM显示，作为BDT的即时效应，吞咽期间UES立即且持续开放，UES压力降低。这表明这些发现代表了该SMA患者吞咽困难的潜在机制。BDT导致UES功能立即改善，可能使吞咽困难得到改善。BDT应与针对UES开放受损的传统康复方法相结合。然而，需要进一步研究以证实BDT对SMA所致吞咽困难的长期有效性。
