Study of pathophysiology in dysphagia

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The purposes of the present study are to reveal the pathogenesis of dysphagia associated with iron deficiency anemia and to know the diagnostic significance of measuring the swallowing pressure in case of dysphagia. Rabbits with iron deficiency were made by feeding them on the meal without iron. Histochemical observations of the pharyngeal and esophageal muscles showed an escape of mitochondria (moth-eaten vies) in the cricopharyngeal muscle. In general, this phenomenon is found in myasthenic diseases. Therefore, it was concluded that dysphagia in case of iron dificiency anemia results from the decrease of constricting power of the muscles acting in swallowing. The measurement of the swallowing pressure in clinical cases also confirmed the above conclusion. A micro-tip pressure transducer was used to measure the swallowing pressure. The swallowing pressure curves obtained by connecting the peaks of the pressure in the pharyngeal and esophageal cavities were classified into the five types: Type I for normals, Type IIa for the increase of the pressure at the entrance of the esophagus, Type IIb for the increase in the hypopharynx, Type IIIa for the decrease in the hypopharynx and Type IIIb for the decrease at the site of velopharyngeal closure. Patients with Type IIa or IIb were treated by administering muscle relaznts, and their dysphagia disappeared with the normalization of the pressure. Patients with iron deficiency anemia had Type IIIa, and their dysphagia improved with the normalization of the pressure after administering iron. Patients with Wallenberg's syndrome had type IIIa, and were successfully treated by the cricopharyngeal myotomy. These results showed that the measurement of the swallowing pressure is a valuable diagnostic tool for evaluating the pathophysiology and a choice of treatment in case of dysphagia.