상부식도조임근 기능장애에서 보툴리눔독소 주입 치료 결과에 대한 인두수축근 힘의 영향
The Influence of Pharyngeal Strength on the Outcome of Botulinum Toxin Treatment for Difficulty in Relaxation of the Upper Esophageal Sphincter
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Objective: Botulinum toxin was used to treat patients with difficulty in relaxation of the upper esophageal sphincter (UES), but the treatment did not always yield good results. We, therefore, attempted to investigate if there was any other factor affecting the outcome and hypothesized that this could be caused due to pharyngeal constriction. Methods: We conducted a retrospective study on a botulinum toxin injection treatment given to eleven patients with nasal backflow and pharyngeal stasis in the course of a videofluoroscopic swallowing study from August 2006 to December 2012. After the injection, the cases showing an esophageal passage of diluted barium regardless of as-piration were defined as “good”, and the cases showing no passage were defined as “bad”. Pharyngeal strength was measured using the pharyngeal constriction ratio (PCR), which was compared between the two groups using the Mann-Whitney U test for proving the hypothesis. Results: Five of the eleven patients showed esophageal passage after the injection treatment and were assigned to the “good” group. The remaining 6 were assigned to the “bad” group. When comparing the average PCR of each group, the ‘good’ group’s ratio was at 0.09±0.03 and the ‘bad’ group was at 0.29±0.16, showing a statistically sig-nificant difference (P＜0.05). Conclusion: The strength of pharyngeal constriction could be considered to be an important factor influencing the outcome after botulinum toxin treatment for the difficulty in relaxation of the UES.
Abstract
Objective: Botulinum toxin was used to treat patients with difficulty in relaxation of the upper esophageal sphincter (UES), but the treatment did not always yield good results. We, therefore, attempted to investigate if there was any other factor affecting the outcome and hypothesized that this could be caused due to pharyngeal constriction. Methods: We conducted a retrospective study on a botulinum toxin injection treatment given to eleven patients with nasal backflow and pharyngeal stasis in the course of a videofluoroscopic swallowing study from August 2006 to December 2012. After the injection, the cases showing an esophageal passage of diluted barium regardless of as-piration were defined as “good”, and the cases showing no passage were defined as “bad”. Pharyngeal strength was measured using the pharyngeal constriction ratio (PCR), which was compared between the two groups using the Mann-Whitney U test for proving the hypothesis. Results: Five of the eleven patients showed esophageal passage after the injection treatment and were assigned to the “good” group. The remaining 6 were assigned to the “bad” group. When comparing the average PCR of each group, the ‘good’ group’s ratio was at 0.09±0.03 and the ‘bad’ group was at 0.29±0.16, showing a statistically sig-nificant difference (P＜0.05). Conclusion: The strength of pharyngeal constriction could be considered to be an important factor influencing the outcome after botulinum toxin treatment for the difficulty in relaxation of the UES.
참고문헌 (22)
- Hila A, "Pharyngeal and upper esophageal sphincter manometry in the evaluation of dysphagia", J Clin Gastroenterol, 33, pp.355~361 (2001)
- Singh S, "The upper oesophageal sphincter", Neurogastroenterol Motil, 17(Suppl 1), pp.3~12 (2005)
- Sivarao DV, "Functional anatomy and physiology of the upper esophageal sphincter", Am J Med, 108(Suppl 4a), pp.27S~37S (2000)
- Cook IJ, "Cricopharyngeal function and dysfunction", Dysphagia, 8, pp.244~251 (1993)
- Regan J, "Botulinum toxin for upper oesophageal sphincter dysfunction in neurological swallowing disorders", Cochrane Database Syst Rev, pp.CD009968~ (2014)
- Moerman MB, "Cricopharyngeal Botox injection : indications and technique", Curr Opin Otolaryngol Head Neck Surg, 14, pp.431~436 (2006)
- Atkinson SI, "Botulinum toxin for cricopharyngeal dysphagia : case reports of CT-guided injection", J Otolaryngol, 26, pp.273~276 (1997)
- Park JW, "Nasal backflow and the difficulty of relaxation in the upper esophageal sphincter", Laryngoscope, 123, pp.966~968 (2013)
- Drozdz DR, "Pharyngeal swallowing phase and chronic cough", Int Arch Otorhinolaryngol, 16, pp.502~508 (2012)
- Rommel N, "Bolus Residue Scale : An Easy-to-Use and Reliable Videofluoroscopic Analysis Tool to Score Bolus Residue in Patients with Dysphagia", Int J Otolaryngol, 2015, pp.780197~ (2015)
- Lee JW, "Subjective Assessment of Videofluoroscopic Swallow Studies", Otolaryngol Head Neck Surg, 156, pp.901~905 (2017)
- Paik NJ, "Categorization of dysphagia diets with the line spread test", Arch Phys Med Rehabil, 85, pp.857~861 (2004)
- Leonard RJ, "Structural displacements in normal swallowing : a videofluoroscopic study", Dysphagia, 15, pp.146~152 (2000)
- Jeong SH, "Endoscopic botulinum toxin injection for treatment of pharyngeal dysphagia in patients with cricopharyngeal dysfunction", Scand J Gastroenterol, 53, pp.1201~1205 (2018)
- Parameswaran MS, "Endoscopic botulinum toxin injection for cricopharyngeal dysphagia", Ann Otol Rhinol Laryngol, 111, pp.871~874 (2002)
- Kocdor P, "Cricopharyngeal dysfunction : A systematic review comparing outcomes of dilatation, botulinum toxin injection, and myotomy", Laryngoscope, 126, pp.135~141 (2016)
- Kuhn MA, "Management of cricopharyngeus muscle dysfunction", Otolaryngol Clin North Am, 46, pp.1087~1099 (2013)
- Chuah SK, "Endoscope-guided pneumatic dilation for treatment of esophageal achalasia", World J Gastroenterol, 16, pp.411~417 (2010)
- Chandrasekhara V, "Endoscopic balloon catheter dilatation via retrograde or static technique is safe and effective for cricopharyngeal dysfunction", World J Gastrointest Endosc, 9, pp.183~188 (2017)
- Terre R, "Long-lasting effect of a single botulinum toxin injection in the treatment of oropharyngeal dysphagia secondary to upper esophageal sphincter dysfunction : a pilot study", Scand J Gastroenterol, 43, pp.1296~1303 (2008)
- Leonard R, "Relationship between fluoroscopic and manometric measures of pharyngeal constriction : the pharyngeal constriction ratio", Ann Otol Rhinol Laryngol, 115, pp.897~901 (2006)
- Leonard R, "Fluoroscopic surrogate for pharyngeal strength : the pharyngeal constriction ratio(PCR)", Dysphagia, 26, pp.13~17 (2011)