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Article

Case Report

J Korean Dysphagia Soc 2020; 10(2): 172-178

Published online July 30, 2020 https://doi.org/10.34160/jkds.2020.10.2.005

Copyright © The Korean Dysphagia Society.

Effect of Repetitive Balloon Dilatation Treatment Confirmed by High-Resolution Manometry in a Patient with Cricopharyngeal Dysfunction: A Case Report

Jaehoon Sim, M.D., Jong Moon Kim, M.D.

Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea

Correspondence to:김종문, 경기도 성남시 분당구 야탑로65번길 11 (13496) 차 의과학대학교 분당차병원 재활의학교실
Tel: 031) 780-5456, Fax: 031) 780-3449
E-mail: jmkim1013@gmail.com

Received: April 7, 2020; Revised: April 17, 2020; Accepted: May 19, 2020

Abstract

Cricopharyngeal dysfunction (CPD) has various treatment options, such as balloon dilatation (BD), botulinum toxin injection, and myotomy of the cricopharyngeal muscle. BD is less invasive, easier to implement, and economical compared to other treatments. In this study, the effectiveness and mechanism of repeating BDs in patients with CPD were verified through a videofluoroscopic swallowing study (VFSS) and high-resolution manometry (HRM). A 44- year-old male developed dysphagia after large epidural hemorrhage in the left-brain hemisphere concurrent with diffuse axonal injury. CPD was confirmed in a videofluoroscopic swallowing study, which he first performed 10 weeks after a traumatic brain injury. Repetitive BDs were performed at 11, 12, 15, 18, 40, and 52 weeks after injury. Before and after the procedure, successive physiological changes were observed by HRM. The UES nadir pressure decreased from 6.4 mmHg to −2. 1 mmHg after the first procedure. The pharyngeal residue after swallowing also decreased below 50% due to relaxation of the upper esophageal sphincter (UES), and the decrease in UES pressure was maintained at 52 weeks. The patient showed improved symptoms and could eat a regular diet. This report supports repetitive videofluoroscopic guided BDs as a therapeutic option for CPD.

Keywords: Upper esophageal sphincter, Dysphagia, Swallowing disorder, Manometry

Article

Case Report

J Korean Dysphagia Soc 2020; 10(2): 172-178

Published online July 30, 2020 https://doi.org/10.34160/jkds.2020.10.2.005

Copyright © The Korean Dysphagia Society.

Effect of Repetitive Balloon Dilatation Treatment Confirmed by High-Resolution Manometry in a Patient with Cricopharyngeal Dysfunction: A Case Report

Jaehoon Sim, M.D., Jong Moon Kim, M.D.

Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea

Correspondence to:김종문, 경기도 성남시 분당구 야탑로65번길 11 (13496) 차 의과학대학교 분당차병원 재활의학교실
Tel: 031) 780-5456, Fax: 031) 780-3449
E-mail: jmkim1013@gmail.com

Received: April 7, 2020; Revised: April 17, 2020; Accepted: May 19, 2020

Abstract

Cricopharyngeal dysfunction (CPD) has various treatment options, such as balloon dilatation (BD), botulinum toxin injection, and myotomy of the cricopharyngeal muscle. BD is less invasive, easier to implement, and economical compared to other treatments. In this study, the effectiveness and mechanism of repeating BDs in patients with CPD were verified through a videofluoroscopic swallowing study (VFSS) and high-resolution manometry (HRM). A 44- year-old male developed dysphagia after large epidural hemorrhage in the left-brain hemisphere concurrent with diffuse axonal injury. CPD was confirmed in a videofluoroscopic swallowing study, which he first performed 10 weeks after a traumatic brain injury. Repetitive BDs were performed at 11, 12, 15, 18, 40, and 52 weeks after injury. Before and after the procedure, successive physiological changes were observed by HRM. The UES nadir pressure decreased from 6.4 mmHg to −2. 1 mmHg after the first procedure. The pharyngeal residue after swallowing also decreased below 50% due to relaxation of the upper esophageal sphincter (UES), and the decrease in UES pressure was maintained at 52 weeks. The patient showed improved symptoms and could eat a regular diet. This report supports repetitive videofluoroscopic guided BDs as a therapeutic option for CPD.

Keywords: Upper esophageal sphincter, Dysphagia, Swallowing disorder, Manometry

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Journal of the Korean Dysphagia Society 2020; 10: 172-178https://doi.org/10.34160/jkds.2020.10.2.005

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