Management of high dysphagia

There may be pointers in a patient's history to a neuromuscular cause of high dysphagia such as neurological disease or a tendency for spillage into the trachea when the patient eats, producing coughing or choking. A patient may find it easier to swallow solids or semisolids rather than liquids and may also complain of nasal regurgitation of food. High dysphagia must be differentiated from globus hystericus (the feeling of having a lump in the throat without any true dysphagia). Globus is a common symptom, and when the patient is examined no abnormality is usually found. It is believed to be a functional disorder but is sometimes associated with gastro-oesophageal reflux.

Generally, radiology is often more rewarding than endoscopy in clarifying the cause of high dysphagia. Cineradiography with liquid barium and bread soaked in barium may give valuable functional as well as anatomical information about the pharynx and cricopharyngeal segment. Most problems are related to failure of pharyngeal contraction or to cricopharyngeal relaxation, or a combination of …