Transition zone defect in patients with motor Dysphagia: A Series of Four patients

Abstract

Introduction: The primary function of the oesophagus is to transfer of liquids and solids to the stomach. There is distinct muscle type as well contraction type above and below transition zone. Defect in coordination and contraction of muscle in this region may leads to abnormal bolus transport resulting in dysphagia. Concurrent high resolution manometry (HRM) and digital fluoroscopy studies showed that defect in transition zone (TZ) was associated with incomplete bolus transport and dysphagia. Aim: To evaluate the frequency of transition zone defect responsible for dysphagia in our primary dysphagia patients and also to evaluate response to drugs. Methods: From July 2010 to December 2012, we performed the HRM on patients with motor dysphagia who were referred for esophageal function testing. Each patient received 10 liquid swallows. We analyzed the results and the manometric findings. Two of the subjects had additional ambulatory 24-h pH study performed to diagnose gastroesophageal refl ux disease (GERD). Results: Among 250 patients, four patients (three male, median age 54 y, range 30-78) had wide transition zone. All four had dysphagia, three predominantly to solid food. Esophago-gastroduodenoscopy was normal in all except one, who had Los Angeles grade A esophagitis. All except one patient with acid reflux had responded poorly to prokinetic therapy. Conclusion: Approximately 2% patients with primary motor dysphagia had wide transition zone and they responded poorly to prokinetic therapy.