Clinical study of columnar balloon dilatation therapy for severe dysphagia caused by upper esophageal sphincter achalasia after stroke

Abstract

Objective To investigate the mechanism and effect of columnar balloon dilatation therapy on treating patients with severe dysphagia caused by upper esophageal sphincter (UES) achalasia after stroke. Methods Sixty -four patients with severe dysphagia caused by UES achalasia after stroke were diagnosed through Video Fluoroscopic Swallowing Study (VFSS) and esophageal dynamics testing. The patients were randomly divided into control group (N = 32) and treatment group (N = 32). Patients in control group were treated with routine drug treatment and routine rehabilitation training, while patients in treatment group were treated with columnar balloon dilatation therapy on the basis of routine treatment. The treatment end point was either the patient resuming an oral diet or after 4-weeks treatment. All cases were evaluated by swallowing function of VFSS, high resolution manometry (HRM) and scores of the severity of dysphagia before treatment and at treatment end point. Results Compared with before treatment, UES resting pressure (P = 0.000) and residual pressure (P = 0.000) were significantly decreased, peak pressure was significantly increased (P = 0.000), duration of relaxation was prolonged (P = 0.000), and scores of the severity of dysphagia were significantly increased (P = 0.000, 0.000) in both groups after treatment. Compared with control group, UES resting pressure (P = 0.001) and residual pressure (P = 0.000) were significantly decreased, peak pressure was significantly increased (P = 0.002), duration of relaxation was prolonged (P = 0.000), and scores of the severity of dysphagia were significantly increased (P = 0.000) in treatment group after treatment. Until the treatment end point or after 4-week treatment, the total effective rate in treatment group was significantly higher than that in control group [93.75% (30/32) vs. 81.25% (26/32); χ² = 4.010, P = 0.000]. Conclusions Columnar balloon dilatation therapy is effective for reducing the tension of upper esophageal sphincter and relieving spasm after stroke. It has obvious therapeutic effect on the upper esophageal sphincter achalasia.

DOI: 10.3969/j.issn.1672-6731.2017.03.005