PDF(Pubmed)
Abstract：
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.
摘要：
球囊扩张疗法（BDT）用于治疗由于咽喉功能障碍导致的上食管括约肌（UES）松弛受损的患者的咽部吞咽困难。然而,这种即时效应的潜在机制尚不清楚.这里,我们提出了一个案例,在该案例中,我们使用高分辨率测压法(HRM)研究了BDT对UES功能障碍的直接影响.一名67岁的男子被诊断患有脊髓性肌萎缩症（SMA）。他逐渐出现吞咽困难,做了胃造口术.尽管继续口服补充营养，患者出现吞咽困难。吞咽的视频透视（VF）检查显示咽部残留物，而HRM显示咽部收缩力弱，UES开放受损。进行BDT以解决UES功能障碍。紧随BDT之后,VF显示咽推注通道改善。至于吞咽过程中的UES功能，HRM显示，UES松弛持续时间明显更长，UES最低点压力显着降低。患者在口服前继续BDT。HRM显示，吞咽过程中UES压力降低，是BDT的直接作用，可立即延长UES开放时间。这表明这些发现代表了该SMA患者吞咽困难的潜在机制。BDT立即改善了UES功能，可能导致吞咽困难的改善。BDT应与常规康复相结合，以治疗受损的UES开口。然而,需要进一步的研究来证实BDT治疗SMA所致吞咽困难的长期有效性.
