Swallowing complaints and cineradiographic abnormalities of the pharynx

Gastrointestinal motility and neurogastroenterology

Nordic research on gastrointestinal motility has since 1965 made substantial contributions to our current understanding of gastrointestinal function. During the last decade, the term neurogastroenterology has widened the concept of motility research into the study of gastrointestinal sensory-motor function, including the complex central nervous system interaction. The discovery of a non-adrenergic non-cholinergic (NANC) innervation of the gut in the sixties was made by considerable contributions from the Nordic countries with the Martinson group in Sweden as central innovators. Important discoveries regarding the intramural nerve ganglia as mediators of the autonomic nervous input has also been produced from this research. In clinical motility research, the study of the migrating motor complex in the small bowel has revealed its ability to act as a retroperistaltic pump in the proximal duodenum (Sweden) and its important role for gut microbial homeostasis (Norway). Also in the development of methodology to study gut sensory-motor function, the Nordic countries has contributed. Examples are the physical characteristics of the esophageal manometry catheter (Denmark), the use of ultrasound for assessment of gastric function (Norway), a temporary electrical stimulation method in patients with severe nausea and vomiting (Sweden), a rectal barostat method for clinical evaluation of recto-anal function and a colonic transit time method utilizing radio-opaque markers (Sweden). In later years, the research collaborations have increasingly become worldwide in a manner making it less easy to define pure Nordic contributions.

Prevalence of swallowing complaints and clinical findings among 50-79-year-old men and women in an urban population

To determine the prevalence of swallowing and esophageal complaints in the general population, 300 men and 300 women were asked to answer a mailed questionnaire. The participation rate was 92.5%. Complaints were reported by 35%. The most common complaints were symptoms associated with gastroesophageal reflux (GER) and globus sensation, both with a rate of occurrence of 20%. Obstruction of the bolus reported by 3% was the individual symptom that most frequently brought patients to the doctor. To validate the questionnaire and to study possible organic causes behind these symptoms, 46 persons with symptoms were invited to undergo further examination. Cineradiography of the pharynx revealed that 7 of 14 patients with symptoms of GER had abnormalities in the esophagus. Eleven of 55 patients with GER symptoms at least once a week underwent endoscopy. One case of erosive esophagitis and one case of gastric ulcer were diagnosed. Four of nine patients with obstructive symptoms had defective closure of the laryngeal vestibule shown by cineradiography. Endoscopy in four patients with obstructive symptoms revealed benign findings. Thus, an epidemiologic study of patients with swallowing symptoms documented a low incidence of serious organic disease.

Endoscopic dilatation and surgical myectomy of symptomatic cervical esophageal webs

During a 10-year period a cervical esophageal web or stricture was diagnosed at rigid endoscopy in 57 patients. Of these patients 72% had restricted their dietary habits because of their symptoms of dysphagia. Cineradiography of the pharynx had revealed abnormalities in 90% of the patients. Dilatation of the webs was performed with semisolid bougies, the endoscope itself, or with balloon inflation. Twelve patients were treated by myectomy of the cricopharyngeal muscle because of unsatisfactory results from the dilatation treatment. Cineradiographic outcome and improvement in dietary habits as a result of the treatment are reported.