motor Disorder.docVIP

The mechanism of swallowing disorders may be either structural or motor. Structural disorders include luminal stenosis and diverticula. Motor disorders include paresis (muscle weakness), sphincteric dysfunction, and spastic disorders.  Structural Disorders Luminal Stenosis Luminal stenosis occurs as a result of mechanical narrowing of the esophageal lumen in patients with esophageal strictures (Figure 9). Symptoms arise when the swallowed food is too large to pass. The typical symptom in a patient with an esophageal stricture is dysphagia for solid food, often followed by regurgitation of undigested material. Figure 9. A, Esophageal stricture showing obstruction of food bolus; B, barium swallow. In general, patients can swallow with little difficulty. This remains true until the swallowing channel is narrowed by about 50%. Even beyond this point, frequency and severity of symptoms may vary substantially, depending on the degree of narrowing, the presence of any associated motor dysfunction, and the choice and preparation of food. Diverticulum A diverticulum is a pouch extending out from the normal wall of the swallowing channel. Diverticula (the plural of diverticulum) can develop in either the pharynx or esophagus (Figure 10). Although small diverticula may not cause symptoms, larger diverticula can cause dysphagia for liquids and solids. Regurgitation of undigested food, often hours after ingestion is a characteristic symptom of patients with diverticula. Figure 10. A, Zenker’s diverticulum; B, esophageal diverticulum. Motor Disorders Paresis Pharyngeal weakness is commonly associated with neurological conditions, such as a cerebral vascular accident, amyotrophic lateral sclerosis (ALS), head and neck trauma, or brain surgery. Severe esophageal weakness is relatively rare. When it does exist, it is characteristically found in patients with certain types of collagen vascular disorders, especially scleroderma and mixed connective tiss