Abstract
Primary cricopharyngeal dysphagia is an uncommon disease associated with a swallowing disturbance at the level of the upper esophageal sphincter and it is characterized by the presence of a prominent cricopharyngeal bar, which can be observed by a radiographic swallowing study. We herein report two cases of primary cricopharyngeal dysphagia that showed different clinical courses. Case 1 was an 80-year-old female who presented with a history of difficulty in swallowing of several years duration. Her swallowing symptoms worsened after the first visit and, as a result, she had lost weight 9.5 kgs (from 34 kg to 24.5 kg) in the following 22 months. She underwent a cricopharyngeal myotomy, and her swallowing symptoms thereafter improved. A histopathological study of her cricopharyngeal muscle showed myopathic changes including atrophy and a decreased number of muscle fibers, interstitial fibrosis, lipomatosis, and lymphocyte infiltration. Case 2 was a 61-year-old male who presented with slight difficulty in swallowing of 4 years duration. While we have followed him for more than 7 years, his swallowing symptoms and findings in radiographic studies have shown no remarkable worsening. Consequently, he has survived to date for 11 years and continues to only have slight difficulty in swallowing. The clinical courses of primary cricopharyngeal dysphagia are therefore likely considered to be diverse, and the treatment strategies should thus be different depending on each specific case.
