Influence of surgery on deglutitive upper oesophageal sphincter mechanics in Zenker's diverticulum
BACKGROUND/AIMS: To evaluate the role of upper oesophageal sphincter (UOS) compliance in dysphagia, the functional consequences of surgery were evaluated in eight patients with pharyngeal diverticula. The study examined the hypotheses that hypopharyngeal intrabolus pressure is an indicator of UOS co...
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| Veröffentlicht in: | Gut 1996-06, Vol.38 (6), p.806-811 |
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| creator | Shaw, D W Cook, I J Jamieson, G G Gabb, M Simula, M E Dent, J |
| description | BACKGROUND/AIMS: To evaluate the role of upper oesophageal sphincter (UOS) compliance in dysphagia, the functional consequences of surgery were evaluated in eight patients with pharyngeal diverticula. The study examined the hypotheses that hypopharyngeal intrabolus pressure is an indicator of UOS compliance and that UOS opening and intrabolus pressure are normalised by surgery. METHODS: In eight patients and nine healthy controls, we measured the timing of swallow events, UOS relaxation, maximal UOS dimensions, intrabolus pressure, and trans-sphincteric bolus flow rates by simultaneous videoradiography and pharyngeal manometry. RESULTS: Bolus flow rates were not changed by surgery. Surgery significantly increased UOS opening (p = 0.0001) and reduced hypopharyngeal intrabolus pressure (p = 0.0001). The slope of the relation between sphincter area and intrabolus pressure was steeper in patients than controls and was normalised by surgery. Surgery had minor effects on basal UOS tone and timing of swallow events. CONCLUSIONS: Upper oesophageal sphincter compliance is poor in Zenker's diverticulum and is normalised by surgery. Hypopharyngeal intrabolus pressure, which correlates with resistance to trans-sphincteric bolus flow, is a useful indicator of UOS compliance. Intrabolus pressure may be a predictor of outcome after myotomy in pharyngeal dysphagia. Cricopharyngeal myotomy is a mandatory component of surgery for Zenker's diverticulum. |
| doi_str_mv | 10.1136/gut.38.6.806 |
| format | Article |
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The study examined the hypotheses that hypopharyngeal intrabolus pressure is an indicator of UOS compliance and that UOS opening and intrabolus pressure are normalised by surgery. METHODS: In eight patients and nine healthy controls, we measured the timing of swallow events, UOS relaxation, maximal UOS dimensions, intrabolus pressure, and trans-sphincteric bolus flow rates by simultaneous videoradiography and pharyngeal manometry. RESULTS: Bolus flow rates were not changed by surgery. Surgery significantly increased UOS opening (p = 0.0001) and reduced hypopharyngeal intrabolus pressure (p = 0.0001). The slope of the relation between sphincter area and intrabolus pressure was steeper in patients than controls and was normalised by surgery. Surgery had minor effects on basal UOS tone and timing of swallow events. CONCLUSIONS: Upper oesophageal sphincter compliance is poor in Zenker's diverticulum and is normalised by surgery. Hypopharyngeal intrabolus pressure, which correlates with resistance to trans-sphincteric bolus flow, is a useful indicator of UOS compliance. Intrabolus pressure may be a predictor of outcome after myotomy in pharyngeal dysphagia. Cricopharyngeal myotomy is a mandatory component of surgery for Zenker's diverticulum.</description><identifier>ISSN: 0017-5749</identifier><identifier>EISSN: 1468-3288</identifier><identifier>EISSN: 1458-3288</identifier><identifier>DOI: 10.1136/gut.38.6.806</identifier><identifier>PMID: 8984014</identifier><identifier>CODEN: GUTTAK</identifier><language>eng</language><publisher>London: BMJ Publishing Group Ltd and British Society of Gastroenterology</publisher><subject>Aged ; Aged, 80 and over ; Analysis of Variance ; Biological and medical sciences ; Case-Control Studies ; Deglutition Disorders - etiology ; Deglutition Disorders - physiopathology ; Deglutition Disorders - surgery ; Diverticulitis - complications ; Esophagogastric Junction - physiopathology ; Esophagus ; Female ; Gastroenterology. Liver. Pancreas. Abdomen ; Humans ; Male ; Malformations ; Manometry - methods ; Medical sciences ; Middle Aged ; Predictive Value of Tests ; Zenker Diverticulum - complications ; Zenker Diverticulum - physiopathology ; Zenker Diverticulum - surgery</subject><ispartof>Gut, 1996-06, Vol.38 (6), p.806-811</ispartof><rights>1996 INIST-CNRS</rights><rights>Copyright BMJ Publishing Group LTD Jun 1996</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b506t-92f4c63620bc6674ea4c4e0c6aebf68527f1b56ced13d3daf3f2f392efed38d43</citedby><cites>FETCH-LOGICAL-b506t-92f4c63620bc6674ea4c4e0c6aebf68527f1b56ced13d3daf3f2f392efed38d43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1383183/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1383183/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=3122866$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8984014$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shaw, D W</creatorcontrib><creatorcontrib>Cook, I J</creatorcontrib><creatorcontrib>Jamieson, G G</creatorcontrib><creatorcontrib>Gabb, M</creatorcontrib><creatorcontrib>Simula, M E</creatorcontrib><creatorcontrib>Dent, J</creatorcontrib><title>Influence of surgery on deglutitive upper oesophageal sphincter mechanics in Zenker's diverticulum</title><title>Gut</title><addtitle>Gut</addtitle><description>BACKGROUND/AIMS: To evaluate the role of upper oesophageal sphincter (UOS) compliance in dysphagia, the functional consequences of surgery were evaluated in eight patients with pharyngeal diverticula. The study examined the hypotheses that hypopharyngeal intrabolus pressure is an indicator of UOS compliance and that UOS opening and intrabolus pressure are normalised by surgery. METHODS: In eight patients and nine healthy controls, we measured the timing of swallow events, UOS relaxation, maximal UOS dimensions, intrabolus pressure, and trans-sphincteric bolus flow rates by simultaneous videoradiography and pharyngeal manometry. RESULTS: Bolus flow rates were not changed by surgery. Surgery significantly increased UOS opening (p = 0.0001) and reduced hypopharyngeal intrabolus pressure (p = 0.0001). The slope of the relation between sphincter area and intrabolus pressure was steeper in patients than controls and was normalised by surgery. Surgery had minor effects on basal UOS tone and timing of swallow events. CONCLUSIONS: Upper oesophageal sphincter compliance is poor in Zenker's diverticulum and is normalised by surgery. Hypopharyngeal intrabolus pressure, which correlates with resistance to trans-sphincteric bolus flow, is a useful indicator of UOS compliance. Intrabolus pressure may be a predictor of outcome after myotomy in pharyngeal dysphagia. Cricopharyngeal myotomy is a mandatory component of surgery for Zenker's diverticulum.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analysis of Variance</subject><subject>Biological and medical sciences</subject><subject>Case-Control Studies</subject><subject>Deglutition Disorders - etiology</subject><subject>Deglutition Disorders - physiopathology</subject><subject>Deglutition Disorders - surgery</subject><subject>Diverticulitis - complications</subject><subject>Esophagogastric Junction - physiopathology</subject><subject>Esophagus</subject><subject>Female</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Humans</subject><subject>Male</subject><subject>Malformations</subject><subject>Manometry - methods</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Predictive Value of Tests</subject><subject>Zenker Diverticulum - complications</subject><subject>Zenker Diverticulum - physiopathology</subject><subject>Zenker Diverticulum - surgery</subject><issn>0017-5749</issn><issn>1468-3288</issn><issn>1458-3288</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1996</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp9kcGL1DAUxoMo67h68yoUFPdix6Rpk_QiyLCrC4PCoB68hDR9mclsm9SkWXb_e7PMMKgHTw_e93sf3-ND6CXBS0Ioe79N85KKJVsKzB6hBamZKGklxGO0wJjwsuF1-xQ9i3GPMRaiJWfoTLSixqReoO7amSGB01B4U8QUthDuC--KHrZDmu1sb6FI0wSh8BD9tFNbUEMRp511es7bEfROOatjYV3xE9wNhItY9PkszFanIY3P0ROjhggvjvMcfb-6_Lb6XK6_frpefVyXXYPZXLaVqTWjrMKdZozXoGpdA9ZMQWeYaCpuSNcwDT2hPe2VoaYytK3AQE9FX9Nz9OHgO6VuhF6Dm4Ma5BTsqMK99MrKvxVnd3LrbyWhghJBs8Hbo0HwvxLEWY42ahgG5cCnKLloWtI0bQZf_wPufQouPycJ5xgzSjnJ1LsDpYOPMYA5RSFYPjQnc3OSCslkbi7jr_6Mf4KPVWX9zVFXUavBBOW0jSeMkqoS7MGmPGA2znB3klW4kYxT3sgvP1Zys97UK1pdyU3mLw58N-7_H_A3cPXAJA</recordid><startdate>19960601</startdate><enddate>19960601</enddate><creator>Shaw, D W</creator><creator>Cook, I J</creator><creator>Jamieson, G G</creator><creator>Gabb, M</creator><creator>Simula, M E</creator><creator>Dent, J</creator><general>BMJ Publishing Group Ltd and British Society of Gastroenterology</general><general>BMJ</general><general>BMJ Publishing Group LTD</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>M7P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>19960601</creationdate><title>Influence of surgery on deglutitive upper oesophageal sphincter mechanics in Zenker's diverticulum</title><author>Shaw, D W ; Cook, I J ; Jamieson, G G ; Gabb, M ; Simula, M E ; Dent, J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b506t-92f4c63620bc6674ea4c4e0c6aebf68527f1b56ced13d3daf3f2f392efed38d43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1996</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Analysis of Variance</topic><topic>Biological and medical sciences</topic><topic>Case-Control Studies</topic><topic>Deglutition Disorders - etiology</topic><topic>Deglutition Disorders - physiopathology</topic><topic>Deglutition Disorders - surgery</topic><topic>Diverticulitis - complications</topic><topic>Esophagogastric Junction - physiopathology</topic><topic>Esophagus</topic><topic>Female</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Humans</topic><topic>Male</topic><topic>Malformations</topic><topic>Manometry - methods</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Predictive Value of Tests</topic><topic>Zenker Diverticulum - complications</topic><topic>Zenker Diverticulum - physiopathology</topic><topic>Zenker Diverticulum - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shaw, D W</creatorcontrib><creatorcontrib>Cook, I J</creatorcontrib><creatorcontrib>Jamieson, G G</creatorcontrib><creatorcontrib>Gabb, M</creatorcontrib><creatorcontrib>Simula, M E</creatorcontrib><creatorcontrib>Dent, J</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>Biological Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Gut</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shaw, D W</au><au>Cook, I J</au><au>Jamieson, G G</au><au>Gabb, M</au><au>Simula, M E</au><au>Dent, J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Influence of surgery on deglutitive upper oesophageal sphincter mechanics in Zenker's diverticulum</atitle><jtitle>Gut</jtitle><addtitle>Gut</addtitle><date>1996-06-01</date><risdate>1996</risdate><volume>38</volume><issue>6</issue><spage>806</spage><epage>811</epage><pages>806-811</pages><issn>0017-5749</issn><eissn>1468-3288</eissn><eissn>1458-3288</eissn><coden>GUTTAK</coden><abstract>BACKGROUND/AIMS: To evaluate the role of upper oesophageal sphincter (UOS) compliance in dysphagia, the functional consequences of surgery were evaluated in eight patients with pharyngeal diverticula. The study examined the hypotheses that hypopharyngeal intrabolus pressure is an indicator of UOS compliance and that UOS opening and intrabolus pressure are normalised by surgery. METHODS: In eight patients and nine healthy controls, we measured the timing of swallow events, UOS relaxation, maximal UOS dimensions, intrabolus pressure, and trans-sphincteric bolus flow rates by simultaneous videoradiography and pharyngeal manometry. RESULTS: Bolus flow rates were not changed by surgery. Surgery significantly increased UOS opening (p = 0.0001) and reduced hypopharyngeal intrabolus pressure (p = 0.0001). The slope of the relation between sphincter area and intrabolus pressure was steeper in patients than controls and was normalised by surgery. Surgery had minor effects on basal UOS tone and timing of swallow events. CONCLUSIONS: Upper oesophageal sphincter compliance is poor in Zenker's diverticulum and is normalised by surgery. Hypopharyngeal intrabolus pressure, which correlates with resistance to trans-sphincteric bolus flow, is a useful indicator of UOS compliance. Intrabolus pressure may be a predictor of outcome after myotomy in pharyngeal dysphagia. Cricopharyngeal myotomy is a mandatory component of surgery for Zenker's diverticulum.</abstract><cop>London</cop><pub>BMJ Publishing Group Ltd and British Society of Gastroenterology</pub><pmid>8984014</pmid><doi>10.1136/gut.38.6.806</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over Analysis of Variance Biological and medical sciences Case-Control Studies Deglutition Disorders - etiology Deglutition Disorders - physiopathology Deglutition Disorders - surgery Diverticulitis - complications Esophagogastric Junction - physiopathology Esophagus Female Gastroenterology. Liver. Pancreas. Abdomen Humans Male Malformations Manometry - methods Medical sciences Middle Aged Predictive Value of Tests Zenker Diverticulum - complications Zenker Diverticulum - physiopathology Zenker Diverticulum - surgery |
| title | Influence of surgery on deglutitive upper oesophageal sphincter mechanics in Zenker's diverticulum |
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