Study of pathophysiology in dysphagia

本研究的目的是揭示缺铁性贫血吞咽困难的发病机制，了解吞咽压力测定对吞咽困难的诊断意义。用不含铁的饲料喂养家兔，造成缺铁。咽部和食管肌的组织化学观察显示颈咽肌中的线粒体逃逸（虫蛀）。一般来说，这种现象见于肌无力性疾病。因此，可以得出结论，在缺铁性贫血的情况下，吞咽困难是由于吞咽肌肉收缩力下降所致。临床病例的吞咽压力测定也证实了上述结论。采用微型压力传感器测量吞咽压力。通过连接咽腔和食管腔压力峰值获得的吞咽压力曲线分为五种类型：正常人为I型，食管入口处压力升高为IIa型，下咽部压力升高为IIb型，下咽部压力降低为IIIa型，下咽部关闭处压力降低为IIIb型。对Ⅱ a型或Ⅱ b型患者给予肌松剂治疗，吞咽困难随着压力恢复正常而消失。患有缺铁性贫血的患者患有IIIa型，并且他们的吞咽困难随着施用铁后压力的正常化而改善。Wallenberg综合征患者为IIIa型，并通过颈咽肌切开术成功治疗。这些结果表明，吞咽压力的测量是一个有价值的诊断工具，用于评估病理生理学和选择治疗的情况下吞咽困难。

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.