Cricopharyngeal Dysfunction in Chronic Obstructive Pulmonary Disease

1 Apr

The intimate developmental and anatomic relation­ships of the tracheobronchial tree and gastrointes­tinal tract have demanded a complex system for separating their functions. The process of swallowing is one aspect. Failure of all or part of this process may lead to aspiration of oropharyngeal contents, a recog­nized pathophysiologic entity which produces, for example, anaerobic pulmonary infections, cough, wheezing, and respiratory distress. In the setting of obvious oropharyngeal dysphagia (with disorders such as brain-stem lesions, muscular disease, eg, polymyo­sitis or myasthenia, and Parkinsons disease), this association may be easily recognized; however, subtle difficulties in passage of solids or liquids from the oropharynx into the upper esophagus are currently little appreciated. In this report, we wish to highlight important aspects of this phenomenon in a group of patients with COPD. We have studied 25 patients with severe obstructive airways disease, 21 of whom had various degrees of cricopharyngeal achalasia. Due to favorable responses to cricopharyngeal myotomy in eight of these patients, we propose that there may be a causal relationship between the two conditions in some patients. While considerable literature on cri­copharyngeal function and dysfunction has been produced, we are not aware of any report raising the possibility that cricopharyngeal dysfunction may be related to or contribute to exacerbations of COPD. buy cheap levitra