[Manometric study of the pharynx and pharyngoesophageal sphincter in myasthenia gravis]

The purposes of this paper are to evaluate degree of dysphagia at the pharyngeal stage of swallowing in patients with myasthenia gravis (Osserman IIB). A catheter with three diode transducers 5 cm apart was swallowed through the nose into the upper esophagus. Firstly a patient was commanded to drink water of 1 ml at about five second intervals, and the swallowing pressures were recorded on condition that the speed of paper recording and catheter pull-through is the same 1 mm/sec. Secondly the swallowing pressures were recorded on condition that the middle transducer is fixed at the level of the upper esophageal sphincter and the speed of paper recording is 5 mm/sec before and after intravenous injection of 10 mg edrophonium chloride. Thirdly the resting pressure of upper esophageal sphincter was recorded on the same condition of the first recording. The results were as follows: (1) All seven patients showed extremely low swallowing pressure at the all level of the pharynx compared with healthy men. (2) At the edrophonium test all seven patients revealed increased percentage of swallowing pressure. (3) One patient showed poor relaxation of the upper esophageal sphincter. (4) The resting pressure of the upper esophageal sphincter was low compared with control. In myasthenia gravis manometric study of the pharynx and the pharyngoesophageal sphincter is a useful method for evaluating swallowing function.