UES Restrictive Disorders

Abstract

The upper esophageal sphincter (UES) is a complex muscle structure that is composed of the cricopharyngeus muscle, the inferior pharyngeal constrictor muscle, and the proximal cervical esophagus. The UES plays an important role in the swallowing process and marks the transition from the pharyngeal deglutitive phase to the esophageal phase. Adequate UES opening is therefore essential for an effective swallow. Failed or diminished UES opening results in incomplete pharyngeal clearance, post-deglutitive residual, and potential post-deglutitive aspiration. Disordered UES opening can be the result of abnormal UES distensibility, such as Zenker’s diverticulum, cricopharyngeal bar, or lack of neural relaxation, such as cricopharyngeal achalasia. Alternatively, it can be due to weak pharyngeal propulsion alone or in addition to failed UES relaxation. For this review, we focus on intrinsic UES restrictive disorders. Major diagnostic tools include videofluoroscopy, endoscopic evaluation of the pharynx and esophagus, and pharyngoesophageal manometry. Treatment options for UES restrictive disorders depend on the underlying etiology and may include surgical or endoscopic methods.