Study of pathophysiology in dysphagia

本研究旨在揭示吞咽困难合并缺铁性贫血的发病机制，了解吞咽困难时测量吞咽压力的诊断意义。用不含铁的饲料喂养缺铁家兔。咽部和食道肌肉组织化学观察显示环咽肌线粒体（虫蛀）逃逸。一般来说，这种现象见于肌无力疾病。因此，我们认为，缺铁性贫血患者的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量也证实了上述结论。采用微针尖压力传感器测量吞咽压力。将咽腔和食管腔内压力峰相连接得到的吞咽压力曲线分为五种类型：I型为正常人，IIa型为食管入口压力升高，IIb型为下咽升高，IIIa型为下咽降低，IIIb型为舌咽部闭合部位压力降低。IIa型和IIb型患者给予肌肉松弛剂治疗，吞咽困难随血压恢复正常而消失。缺铁性贫血患者为IIIa型，服用铁后血压恢复正常，吞咽困难得到改善。Wallenberg综合征患者为IIIa型，经环咽肌切开术成功治疗。这些结果表明，吞咽压力的测量是评估吞咽困难的病理生理和治疗选择的有价值的诊断工具。

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.