Cricopharyngeal Achalasia

Cricopharyngeal Achalasia

By: Dr. Nicholas Trout

Section: Veterinary Care In-depth

Diagnosis In-depth

  • Your veterinarian will take a detailed history, focusing on the nature of swallowing, whether there is passive regurgitation or active vomiting.

  • A general physical examination will assess your dog's general health, focusing on body weight, listening to the chest and palpating the throat and neck, before looking inside the mouth itself.

  • Your dog will be observed drinking water and then eating a small meal to try to determine whether the problem is truly pharyngeal, and not oral or related to the esophagus. Oral disorders usually cause difficulty in getting food up into the mouth and rolled in a ball, or bolus, at the back of the throat ready for swallowing.

    Pharyngeal disorders usually cause difficulty in the actual propulsion of the bolus from the back of the throat into the esophagus. Cricopharyngeal achalasia usually causes more difficulty in swallowing food than liquids.
    Other pharyngeal disorders tend to have more difficulty with swallowing liquids.

  • Chest x-rays will be taken to evaluate the lungs for pneumonia and the esophagus for size.

  • The definitive diagnosis of cricopharyngeal achalasia is made by fluoroscopy, a moving X-ray image that can monitor a barium coated meal as it is swallowed. To tell the difference between cricopharyngeal achalasia and other forms of pharyngeal dysphagia takes a skilled and experienced radiologist. The study may be recorded on videotape and reviewed by other radiographic specialists before a final decision is made.

  • The study should show that the pharynx is strong and pushes a bolus of food toward the esophagus, but the opening, formed by the cricopharyngeal muscle ring, stays shut, or opens at the wrong time. Other pharyngeal disorders often show that the pharynx lacks the strength to push the food from the back of the throat and into the esophagus. The passage of the food along the esophagus can be monitored to make sure it is normal.

    Treatment In-depth

  • If the swallowing problem is purely due to cricopharyngeal achalasia, then surgery is the treatment of choice and is usually curative. It is important that the dog is in the best possible health going into surgery. This may mean using antibiotics to treat pneumonia, providing intravenous fluids to offset dehydration, or even placing a feeding tube into the stomach for a few days prior to surgery to make sure the patient is adequately nourished.

  • Your dog will be shaved on the underside of the neck and an incision made over the junction of the pharynx and the larynx, to gain access to the abnormal cricopharyngeal muscle group. The muscle group on both sides is either cut, or a portion of each muscle group cut out.

    There is no medical option for treatment because the problem is produced by the constricting dysfunction of this muscle group.

     
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