Has there been a neuro consult? what is pharyngeal stasis. 37(12):1210-9. On frontal views during swallowing, pouches appear as transient, hemispheric, contrast-filled protrusions from the lateral hypopharyngeal wall, below the hyoid bone and above the calcified edge of the thyroid cartilage ( Fig. The quiet cry may suggest retracted tongue (? 208(6):1035-44. Patients with second branchial cleft cysts usually present between the ages of 10 and 40 years with a painless or fluctuant mass in the upper neck along the upper third of the anterior border of the sternocleidomastoid muscle. No documented abnormalities exist regarding the distribution of myenteric neurons in patients diagnosed with spastic motility disorders of the esophageal body, but diffuse fragmentation of vagal filaments, increased endoneural collagen, and mitochondrial fragmentation are described. Current clinical approach to achalasia. 16-13 ). Lateral view of the pharynx shows well-circumscribed plaques (. Whether gastroesophageal reflux predisposes patients with a large Killian dehiscence to the formation of Zenkers diverticulum is unknown. The first branchial cleft forms the external auditory meatus. National Library of Medicine A sensation of food getting stuck in the throat or chest or behind the breastbone (sternum) Drooling. Praveen K Roy, MD, MSc Clinical Assistant Professor of Medicine, University of New Mexico School of Medicine [QxMD MEDLINE Link]. Can dysphagia be cured by surgery? A dynamic examination reveals a higher percentage of webs than spot images alone. Approximately 50% of patients complain of hearing loss because of eustachian tube involvement. When decreased base of tongue movement, impaired pharyngeal pressure generation, and presence of pharyngeal residue are noted during a VFSS, a neurologic etiology can be suspected. Considerable variation is found in the arrangement of the muscle bundles of the thyropharyngeal and cricopharyngeal muscles. Epub 2021 Feb 5. A lateral pharyngeal diverticulum is a protrusion of nonkeratinizing squamous mucosa originating in the pharynx. Anteriorly, there is the larynx, epiglottis, and posterior part of the tongue. In Laufer I, Levine MS [eds]: Double Contrast Gastrointestinal Radiology, 2nd ed. The junction of the ala of the thyroid cartilage and thyrohyoid membrane is seen on frontal views as a notch in the lateral pharyngeal wall. Familial clustering is observed, but a genetic relationship is not established. The upper esophageal sphincter (UES) is comprised of several striated muscles, creating a tonically closed valve and preventing air from entering into the gastrointestinal tract. Achalasia affects both sexes in equal numbers. At rest, the barium-filled diverticulum extends below the level of the cricopharyngeal muscle posterior to the proximal cervical esophagus ( Fig. official website and that any information you provide is encrypted Increased incidence of both esophageal squamous cell and adenocarcinoma is observed in patients with long-standing achalasia. In lymphoid hyperplasia of the palatine tonsils, masslike enlargement of the palatine tonsils is seen in the frontal and lateral views ( Fig. Scintigraphy also had good sensitivity in detecting penetration and/or aspiration in VFS. Cricopharyngeal dysfunction is most common in older adults. Furthermore, the examination can detect coexisting structural lesions (e.g., prominent cricopharyngeal muscle, Zenkers diverticulum, web, stricture) that may be difficult to circumvent safely at endoscopy. Note the "bird-beak" appearance of the lower esophageal sphincter (LES), with a dilated, barium-filled esophagus proximal to it. At the time of diagnosis, the esophagus usually is dilated, and the tumor is advanced. 2017 Feb 1. Squamous cell carcinomas that affect the epiglottis, aryepiglottic folds, mucosa overlying the arytenoid cartilages, false vocal cords, and laryngeal ventricles are defined as supraglottic carcinomas. Retention cysts of the aryepiglottic folds are lined by squamous epithelium and filled with desquamated squamous debris ( Fig. Dig Dis Sci. Muller M, Eckardt AJ, Gopel B, Eckardt VF. Enter your email address to subscribe to this blog and receive notifications of new posts by email. This can cause speech that is difficult to understand. On barium studies, irregularity of the contour of Zenkers diverticulum should suggest an inflammatory or neoplastic complication. 57(3):683-9. In the United States, no strong association of cervical esophageal webs, iron deficiency anemia, and pharyngoesophageal carcinoma has been found. Uncoordinated or abnormal muscles in the mouth, throat or esophagus. 2014. See the images below. Image courtesy of Andrew Taylor, MD, Professor, Abdominal Imaging, Department of Radiology, University of Wisconsin Medical School, Madison. The pathogenesis is not well documented, but chronic mucosal irritation is incriminated. [QxMD MEDLINE Link]. Greatly increased prevalence of esophageal dysmotility observed in persons with spinal cord injury. Brooks, L., Landry, A., Deshpande, A., Marchica, C., Cooley, A., & Raol, N. (2020). Systemic complications are the major cause of mortality. Radiographic description of this phenomenon has been called presbyesophagus. A barium examination can also be used to rule out a second primary lesion in the esophagus. sharing sensitive information, make sure youre on a federal Esophageal stasis was the most common finding regardless of complaint location. Although acute epiglottitis usually affects children between 3 and 6 years of age, it occasionally causes severe stridor and sore throat in adults. Exophytic lesions are more common ( Fig. Overall low energy and alertness for his age. The webs are seen as isolated findings in 3% to 8% of patients undergoing upper GI barium studies. A true Zenkers diverticulum may be confused with barium trapped above a cricopharyngeal muscle that has closed before the pharyngeal contraction wave has passed. On lateral radiographs, the base of the tongue may seem to protrude posteriorly. However, the impact of posterior tongue ties on the pharyngeal phase of swallowing is not well documented in the literature. American Neurogastroenterology and Motility Society, American Society for Gastrointestinal Endoscopy, American College of Physicians-American Society of Internal Medicine. Esophageal stasis was the most common finding regardless of complaint location. All signs seem to be pointing to a neurological basis for his dysphagia and Im just wondering if there are any last hail marys to try before we start to plan for home on NG, OP feeding therapy, etc. Clin J Gastroenterol. This work supports a comprehensive evaluation of both the pharynx and the esophagus for patients with complaints of bolus stasis in the throat. They should be well informed about its lifelong nature. Nodules of tumor may spread to the palatine tonsil, valleculae, or pharyngoepiglottic fold. The barium examination can also show areas behind bulky tumors that are difficult to visualize by endoscopic examination. [QxMD MEDLINE Link]. Efficient transport by the esophagus requires a coordinated, sequential motility pattern that propels food from above and clears acid and bile reflux from below. They are usually unilateral. In general, they occur in two macroscopic forms: (1) exophytic tumors that spread over the mucosa; and (2) infiltrative or ulcerative tumors that penetrate deeply into surrounding soft tissue, cartilage, and bone. Conclusion Patients are poor at localizing bolus stasis, and esophageal stasis is common in patients who complain of pharyngeal stasis. However, barium studies may reveal enlargement of the aryepiglottic fold with a smooth overlying mucosa. Associated complications, including strictures, Barrett esophagus, and adenocarcinoma of the esophagus, are the concern. Patients with lateral pharyngeal pouches usually have no symptoms. Philadelphia, WB Saunders, 1992. He also has a high palate and often is nasally congested. An intraluminal mass may be manifested radiographically by obliteration of the normal luminal contour, extra barium-coated lines protruding into the expected pharyngeal air column, a focal area of increased radiopacity, or a filling defect in the barium pool. The webs protrude to various depths into the esophageal lumen. Occasionally, a deeply infiltrating, primarily submucosal lesion may be manifested by subtle asymmetric enlargement of the tongue base. An official website of the United States government. Such patients usually demonstrate normal findings on pharyngograms or evidence of nonspecific lymphoid hyperplasia of the palatine or lingual tonsils. When decreased base of tongue movement, impaired pharyngeal pressure generation, and presence of pharyngeal residue are noted during a VFSS, a neurologic etiology can be suspected. On frontal radiographs obtained in patients with lymphoid hyperplasia, multiple smooth, round, or ovoid nodules are symmetrically distributed over the surface of the base of the tongue ( Fig. Other diseases of pharynx. 16-10 ). Branchial pouch sinuses arise from the tonsillar fossa (second pouch), upper anterolateral piriform fossa (third pouch), or lower anterolateral piriform sinus (fourth pouch; Fig. 233 0 obj <>/Filter/FlateDecode/ID[<9925DAB172E4C04EAA11C856BA143EA3>]/Index[223 23]/Info 222 0 R/Length 65/Prev 694135/Root 224 0 R/Size 246/Type/XRef/W[1 2 1]>>stream There are no skeletal structures in the fourth pharyngeal arch. This association was termed Plummer-Vinson syndrome or Paterson-Kelly syndrome. endstream endobj startxref hbbd``b`>$4 DxHdrS@I#3~` ) The degree of ganglion cell loss parallels the disease duration such that, at 10 years, ganglion cells are likely completely absent. Racial differences in the incidence of achalasia and other esophageal motility disorders have not been established. Deciphering Oral Stasis: Managing the Challenging Combination of Dementia and Dysphagia - Part I Presenter: Michelle Tristani, M.S., CCC-SLP Moderated by: Amy Natho, M.S., CCC-SLP, CEU Administrator, SpeechPathology.com 1 . Barium that is retained in pouches during swallowing spills into the ipsilateral piriform sinus after the bolus passes. Dysphagia. 16-7 ) and do not empty as quickly after swallowing. The cases were divided into two groups based on whether the . All the etiologies that I mentioned, in isolation or in combination, could play a part in the diffuse pharyngeal stasis/residue observed, which is worrisome for bolus mis-direction during the course of a true feeding. Achalasia is the best defined primary motility disorder and the only one with an established pathology. 16-6 ). We present a 21-month-old patient with significant pharyngeal phase dysphagia which was most saliently characterized by impaired base of tongue movement, poor pressure generation, and diffuse residue resulting in aspiration. Muscles of the oral cavity, pharynx, and cervical esophagus are of the striated variety. 2021 Apr;30(4):105349. doi: 10.1016/j.jstrokecerebrovasdis.2020.105349. The LES relaxes during swallows and stays opened until the peristaltic wave travels through the LES, then contracts and redevelops resting basal tone. These poorly differentiated or undifferentiated tumors spread rapidly to the entire supraglottic region and pre-epiglottic space. Initial results of diagnostic endoscopy may be negative. 2018 Jul;66(7):543-549. doi: 10.1007/s00106-017-0365-5. Esophagram of a 65-year-old man with rapid-onset dysphagia over 1 year. This work supports a comprehensive evaluation of both the pharynx and the esophagus for patients with complaints of bolus stasis . The pharynx, usually called the throat, is part of the respiratory system and digestive system. Conclusion Patients are poor at localizing bolus stasis, and esophageal stasis is common in patients who complain of pharyngeal stasis. Clinical symptoms may include dysphagia, choking, cough, hoarseness, regurgitation of undigested food, or a painless neck mass. ENT did not find any structural issues, but his cry is described as quiet by nurses. van Hoeij FB, Tack JF, Pandolfino JE, et al. 16-14 ). Diagnostic Accuracy of an Esophageal Screening Protocol Interpreted by the Speech-Language Pathologist. These tumors may spread laterally to the pharyngoepiglottic folds and lateral pharyngeal walls. Hoarseness. In DES, muscular hypertrophy or hyperplasia has been described in the distal two thirds of the esophagus. Conclusion Patients are poor at localizing bolus stasis, and esophageal stasis is common in patients who complain of pharyngeal stasis. In contrast, saccular cysts of the aryepiglottic folds arise from the mucus-secreting glands of the appendix of the laryngeal ventricle and are filled with mucoid secretions. Cross-sectional imaging studies are the examinations of choice for showing spread of tumor into the submucosa, intrinsic muscles, tissues extrinsic to the pharynx, and regional lymph nodes. [QxMD MEDLINE Link]. The fourth and sixth pharyngeal arches cartilages merge to give rise to the laryngeal cartilages. Obliteration of the contour indicates that the lateral and inferior piriform sinus has been replaced by a soft tissue mass (. Would you like email updates of new search results? Dig Dis Sci. In immunosuppressed patients with acute dysphagia, barium studies are directed toward the esophagus to demonstrate the presence, site, and type of esophagitis. The 2 best-characterized motility disorders, achalasia and DES, represent only a small percentage of diagnosed motility disorders. The risk typically starts increasing after approximately 10 years of having the disease process. coughing or choking when eating or drinking. Esophageal motility disorders are not uncommon in gastroenterology. Some diseases with diffuse mucous membrane ulceration affect the pharynx. He was eventually diagnosed with a posterior tongue tie and underwent a frenulectomy. Patients with benign tumors of the base of the tongue may be asymptomatic or may complain of throat irritation or dysphagia. Nonepithelial tumors arising from the supporting tissues of the pharynx are rare. With severe ulceration, amputation of the uvula and tip of the epiglottis may be observed radiographically. The proximal esophagus is predominantly striated muscle, while the distal esophagus and the remainder of the GI tract contain smooth muscle. [QxMD MEDLINE Link]. Transient or persistent protrusions of the anterolateral cervical esophagus into the Killian-Jamieson space are termed lateral cervical esophageal pouches or diverticula, respectively. [QxMD MEDLINE Link]. Several older northern European series showed an association of cervical esophageal webs, iron deficiency anemia, and pharyngeal or esophageal carcinoma. [4] Features of esophagealmotilityafter endoscopic sclerotherapy are a defective lower sphincter and defective and hypotensive peristalsis. Postgrad Med. A videofluoroscopic swallow study (VFSS) allows for visualization of the oral, pharyngeal, and esophageal phases of the swallow. Some background: He is an ex 33-weeker, now 39+5. A recent study (22) showed that the quantification of the oral or pharyngeal stasis (defined as a residue in the oral cavity, in the pharynx during swallowing) in the videofluoroscopic assessment is limited to a subjective character. used kompact kamp mini mate for sale. Barium studies allow detection of more than 95% of structural lesions below the pharyngoesophageal fold. Tumors of the epiglottis and aryepiglottic folds may also result in dysphagia, coughing, or choking because of laryngeal penetration. Squamous cell carcinomas of the base of the tongue are poorly differentiated lesions that often present as advanced lesions with nodal metastases. Problem-Solving with Catherine: Adenoid Hypertrophy and Pediatric Dysphagia, Problem-Solving: New infant referral but limited experience, Problem-Solving with Catherine: 3-month-old with TEF and Vocal Cord Paralysis, Lifelong Learners Join Catherine in Houston, State-of-the-Art NICU Practice: Catherine Shaker and Suzanne Thoyre. No overlap of fibers exists between the thyropharyngeal and cricopharyngeal muscles. The underlying cause of all the primary motility disorders remains elusive. It carries air, food and fluid down from the nose and mouth. This work supports a comprehensive evaluation of both the pharynx and the esophagus for patients with complaints of bolus stasis in the throat. Inability to swallow. [Temporal and spatial pattern analysis of pharyngeal swallowing in patients with abnormal sensation in the throat]. As a result, pending further data, they might consider a G-Tube with a Nissen (to optimize airway protection and more safely buy him time for response to therapy and evolution to guide the differential), instead of home NG, which would have its own attendant sequelae. being unable to chew food properly. In addition, anxiety states may also play a role in some patients. Please enable it to take advantage of the complete set of features! MRI is the method of choice for evaluating tumors of the nasopharynx. Nasal regurgitation was observed during the initial double-contrast swallow. A zone of lymphoid tissue surrounds the epithelium. External and internal laryngoceles do not fill with barium on pharyngograms. If symptoms progress, then the workup should be repeated because DES can progress to achalasia. hTmo6+bpNQ@av@A9G^I;Rr$;Y\#0"&Z2-t2& #WBq#@ @+$>EWuO72Ou-Zs*[P Jd|!6kSKWEsw]J]WfDvNj _i8n[&7gsct These tracts are lined by ciliated columnar epithelium. 16-8 ). Peristalsis is a sequential, coordinated contraction wave that travels the entire length of the esophagus, propelling intraluminal contents distally to the stomach. Diffuse residue, hard to quantify as it varied throughout the study, but definitely not a littleenough that poses a risk for aspiration post-swallow/as feeding continues. Among the VFSSs, those showing pharyngeal stasis by mechanical obstruction due to cervical osteophytes were selected for inclusion in this study. Better demonstration of webs is also achieved with the use of large boluses of barium. The mid esophagus contains a graded transition of striated and smooth muscle types. There appears to be a functional imbalance between excitatory and inhibitory postganglionic pathways, disrupting the coordinated components of peristalsis. The relationship between gastroesophageal reflux disease and Zenkers diverticulum is also controversial. Food coming back up (regurgitation) Frequent heartburn. Significant acid reflux might lead to disabling symptoms, caused by reflux or its complications. With the partial ganglion cell loss in patients with achalasia, edrophonium (acetylcholine esterase inhibitor) increases LES pressure while atropine (muscarinic antagonist) decreases LES pressure. Catherine Shaker Swallowing and Feeding Seminars, Research Corner: Infant and maternal factors associated with attainment of full oral feeding (FOF) in premature infants. Crit Rev Diagn Imaging 28:133179, 1988. The loss of nerves along the esophageal body causes aperistalsis, leading to stasis of ingested food and subsequent dilation of the esophagus. Complications of botulinum toxin injections for treatment of esophageal motility disorders. 16-4 ). Pathologically, a unilocular cyst is lined by keratinizing, stratified, squamous epithelium and is filled with desquamated keratinaceous debris. 2010 Feb. 22(2):142-9, e46-7. Most patients with cervical esophageal webs are asymptomatic. Barium studies of the pharynx are usually of limited value in patients with acute sore throat caused by viral, bacterial, or fungal infection. 223 0 obj <> endobj Because such a strong association exists between head and neck squamous cell carcinoma and esophageal carcinoma, a major goal of a preoperative radiologic study is to rule out a synchronous primary esophageal cancer. In addition to alcohol and smoking abuse, poor ventilation, nasal balms, ingested carcinogens, and upper respiratory viruses such as the Epstein-Barr virus have been implicated as causative factors. government site. Catherine Shaker Seminars: Formula One Style in Austin! [1] As with any other chronic illness, prevalence exceeds incidence significantly. An ulcerated lesion appears as an irregular barium collection disrupting the expected contour of the base of the tongue. Dis Esophagus. for stability and/or r/t tethered oral tissues, r/t mild mandibular hypoplasia). Please confirm that you would like to log out of Medscape. 2015 Jul. This is the American ICD-10-CM version of J39.2 - other international versions of ICD-10 J39.2 may differ. Measurement of Pharyngeal Residue From Lateral View Videofluoroscopic Images Catriona M. Steele,a,b Melanie Peladeau-Pigeon,a Ahmed Nagy,a,c,d and Ashley A. Waitoa Purpose: The field lacks consensus about preferred metrics for capturing pharyngeal residue on videofluoroscopy. [QxMD MEDLINE Link]. The radiologist carefully searches for spread to the nasal cavity, sinuses, and cranial base, especially for cranial nerve involvement. Results Dysphagia evaluation was completed in 301 patients with complaints of bolus stasis. A referred earache may occur, especially when nasopharyngeal tumors block the eustachian tube. 12:CD005046. Patients with complaints of bolus stasis in the throat (i.e., pharynx and cervical esophagus) were less accurate at localizing bolus stasis than patients with complaints in the thoracic esophagus ( p < .001). In the peristaltic esophageal body, achalasia is characterized by a loss of intrinsic acetylcholine-containing nerves. Pacifier dips in a secure swaddle elevated side lying position would allow for purposeful swallows and motor learning yet reduce risk for airway invasion, given that etiology is not fully clear. cess. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. The use of endoscopy and magnetic resonance imaging (MRI) may help exclude malignancy. HNO. The tubular esophagus is a muscular organ, approximately 25 cm in length, and has specialized sphincters at proximal and distal ends. Sinus tracts that end blindly are occasionally seen in adults. Benign cartilaginous tumors involving the pharynx (chondromas) usually arise from the posterior lamina of the cricoid cartilage. 144(4):718-25; quiz e13-4. Posterior tongue tie, base of tongue movement, and pharyngeal dysphagia: what is the connection?. Lymphoid hyperplasia of the base of the tongue. Scarring may cause distortion of the pharyngeal contours. Squamous cell carcinoma is the most common histologic type of nasopharyngeal malignant tumor. Symptoms are related primarily to the location and polypoid or sessile nature of the lesion. Low peristaltic amplitudes normally occur at the transition zone between the striated and smooth muscle portions; however, the peristalsis is uninterrupted. Carlson DA, Ravi K, Kahrilas PJ, et al. Eckardt AJ, Eckardt VF. Some patients are asymptomatic but present with a palpable neck mass. [QxMD MEDLINE Link]. 16-17 ). Sonnenberg A. Only rarely is a pedunculated polypoid lesion (e.g., papilloma, fibrovascular polyp) seen. ), Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Structural Abnormalities of the Pharynx, Miscellaneous Abnormalities of the Stomach and Duodenum, Pharynx: Normal Anatomy and Examination Techniques. MeSH Future research should focus on identifying symptom profiles that could lead . Benign tumors arising from the minor mucoserous salivary glands are usually seen in the oropharynx in the region of the soft palate and base of the tongue. Leyden JE, Moss AC, MacMathuna P. Endoscopic pneumatic dilation versus botulinum toxin injection in the management of primary achalasia. Scleroderma esophagus is associated with severe and progressive acid reflux symptoms and complications. Plain radiographic diagnosis of acute epiglottitis is important (even in adults) because manipulation of the tongue or pharynx may exacerbate edema and respiratory distress. This work supports a comprehensive evaluation of both the . Barium is retained in the right and left lateral pharyngeal pouches (, Spot radiograph of the pharynx obtained with patient in a left posterior oblique position shows a thin, 1.5-cm barium-filled track (. The secondary motility disorders, such as scleroderma esophagus or esophageal motility disorder of diabetes, are better understood from the standpoint of the preexisting underlying disorders. The muscle is oriented in 2 perpendicular opposing layers: an inner circular layer and an outer longitudinal layer, known collectively as the muscularis propria. 18(7):[QxMD MEDLINE Link]. Before Lateral Pharyngeal Pouches and Diverticula, Branchial Cleft Cysts, Branchial Cleft Fistulas, and Branchial Pouch Sinuses, Lateral Cervical Esophageal Pouches and Diverticula, Lymphoid Hyperplasia of the Lingual and Palatine Tonsils, Surgery for Tongue and Oropharyngeal Cancers, Surgery for Zenkers Diverticulum and Pharyngeal Pouches. Likely at risk for bolus mis-direction from below (refluxate), d/t what sounds like proximal hypotonia that could make timely effective response to retrograde flow from the esophageal body unreliable. Killian-Jamieson diverticula can be bilateral or unilateral. 22(2):226-30. [QxMD MEDLINE Link]. The cricopharyngeal muscle has no midline raphe. Image courtesy of Andrew Taylor, MD, Professor, Abdominal Imaging, Department of Radiology, University of Wisconsin Medical School, Madison. Inflammation-induced dysmotility may result in laryngeal penetration and stasis. Pharyngeal airway changes in Class III patients treated with double jaw orthognathic surgery-maxillary advancement and mandibular setback. Federal government websites often end in .gov or .mil. Food or stomach acid backing up into the throat. A combination of internal and external laryngocele is termed a mixed laryngocele. A laryngocele is a protrusion of ciliated pseudostratified columnar epithelium and loose areolar connective tissue arising from saccular dilation of the appendix of the laryngeal ventricle. Search google scholar for this article by my colleague and friend, Laura Brooks, which may or may not be pertinent, pending your further assessment and refection. In contrast, lateral pharyngeal diverticula are persistent protrusions of pharyngeal mucosa, usually through the thyrohyoid membrane or, rarely, through the tonsillar fossa. [QxMD MEDLINE Link]. Gravesen FH, Gregersen H, Arendt-Nielsen L, Drewes AM. Thanks for such a detailed history to help to consider possibilities. PMC Hospitalization for achalasia in the United States 1997-2006. Primary esophageal motility disorders are idiopathic in nature, but postviral, infectious, environmental, and genetic factors have been hypothesized. Squamous cell carcinomas of the head and neck (e.g., tongue, pharynx, larynx) constitute 5% of all cancers in the United States, whereas esophageal carcinomas constitute only 1% of all cancers. A frontal view shows loss of the normal contour of the left piriform sinus. list of sundown towns in new england; jeff mudgett wikipedia. When small, the cysts are anterior to the sternocleidomastoid muscle. Possible complications, therapeutic options, expected outcomes, and dietary modifications should be explained. This infant has pharyngeal stasis post swallow on the swallow study. a sensation that food is stuck in your throat or chest. For patient education resources, seeHeartburn and GERD CenterandDigestive Disorders Center, as well asAcid Reflux (GERD)andHeartburn. Clipboard, Search History, and several other advanced features are temporarily unavailable. Anatomically, the circular muscle layer at the LES is thickened, but, microscopically, individual muscle cells are grossly normal. In some patients, this regurgitation of barium results in overflow aspiration. Some webs show inflammatory changes. Farmer's Empowerment through knowledge management. 16-1 ). Some tumors may be detected during barium studies performed for other reasons. On frontal views, pouches appear as small, round, or ovoid protrusions of the lateral upper esophageal wall that are filled late during swallowing and that empty after swallowing. In patients with chronic sore throat, barium studies may help determine whether underlying gastroesophageal reflux and reflux esophagitis are present. This delayed spill may result in dysphagia or a choking sensation because of overflow aspiration. RadioGraphics 8:641665, 1988.). Spastic esophageal motility disorders are associated with symptomatic discomfort but do not lead to the severity of dysphagia observed in patients with achalasia. Manometry demonstrates diffuse esophageal spasm with simultaneous contractions of the esophagus observed throughout the tracing. Method This study used a prospective analysis of outcomes data from the University of Wisconsin-Madison Voice and Swallow Outcomes database in patients with complaints of bolus stasis who completed the combined videofluoroscopic swallowing study and esophagram to determine the accuracy of bolus stasis localization. Ineffective esophageal motility (IEM): the old-new frontier in esophagology. Primary peristalsis is the peristaltic wave triggered by the swallowing center.