Newer concepts of the physiology of deglutition and dysphagia

The development of technics for the accurate measurement and recording of esophageal intraluminal pressure coupled with careful roentgenographic observation have advanced our knowledge of the mechanical factors involved in deglutition and dysphagia. Transport within the esophagus is dependent upon intact mechanisms which are capable of creating a pressure gradient. A definite and characteristic normal deglutition pressure pattern is recognized. Abnormal pressure patterns as a result of local or systemic disease may produce a loss of pressure gradient and result in dysphagia. The exact mechanism of esophageal evacuation is still somewhat in doubt and further study is needed to elucidate the action of the distal end of the esophagus. The esophagogastric junction is a delicately integrated structure and disturbances may produce a functional obstruction or allow esophageal reflux. A number of mechanical, inflammatory, neoplastic, neurologic and psychic disorders may produce dysphagia by interfering with one or more of the stages of deglutition. Dysphagia may indicate a serious condition; therefore, its presence usually warrants a thorough investigation, including roentgenographic and endoscopic examination of the pharynx and esophagus.