Feeling of gas passing water in neck when swallowing food

Introduction Patients with cyclopinopharyngeal achalasia have swallowing pain, obstruction, foreign body sensation, difficulty swallowing, prolonged meal time; drinking liquid can cause cough. When the food swallows, the neck has a feeling of gas and water. The peristalsis of the esophagus begins when the UESM contracts. If a certain factor causes uncoordinated swallowing activity, or the pharyngeal muscle contraction is ineffective, the UESM may not be completely loose or slack in advance, and dysphagia may occur. Most of them occur in middle-aged and elderly women. People with impatience or anxiety are more likely to have difficulty swallowing food when they eat. The food stays in the oropharynx and cannot enter the esophagus. Therefore, the meal time is greatly prolonged; if it is liquid, it is mistaken after swallowing. Inhalation of the respiratory tract causes coughing. There is also a sense of swallowing pain, foreign body sensation, or a feeling of weight loss in the neck when the food is swallowed.

Cause

(1) Causes of the disease

The dysfunction of the pharyngeal muscle group can be caused by degeneration of nerves or muscles.

1. Neuromuscular diseases: Patients with cerebrovascular accidents may have language disorders and expression disorders. The linguistic disorder may be accompanied by an inconsistency in the activity of the upper esophageal sphincter muscle (UESM) and difficulty in the formation and advancement of the bolus. Amytrophic lateral sclerosis may result in loss of voluntary swallowing, dyslexic disorder, and repeated aspiration due to loss of motor neurons and control functions. Riley-Day syndrome is a congenital familial autonomic dysfunction characterized by straight sternal hypotension, low sweating, bladder and sexual dysfunction. Such patients have abnormalities in the chemical or mechanical susceptibility of the respiratory center, so dyspnea often occurs, and their arterial oxygen saturation (SaO2) is significantly reduced, and there are simultaneous hypopharyngeal disorders. Huntingtons chorea is an age-related neurological disorder characterized by involuntary movements in various parts of the body and hypopharyngeal disorders in the oropharynx. Patients with Parkinsons disease are slow to form a bolus, and there is often a delay in starting the hypopharynx. Progressive systemic sclerosis is a connective tissue disease in which 50% of these patients are affected by esophageal function. Colman (1999) reported a group of 36 patients with this disease for esophageal motor function tests, and found that 33 of them had esophageal motor dysfunction.

2. Myogenic disease: skeletal muscle of the pharyngeal myasthenia gravis, UESM and 1/4 of the upper esophagus are often involved, causing a special difficulty in swallowing, often accompanied by cough, phlegm and food reflux into the nasal cavity. . This phenomenon is not due to obstruction of the pharyngeal muscles or the inability to relax, but the weakness of the muscles due to the weakness of the soft diaphragm muscles, so that the nasopharynx cannot be completely blocked during swallowing (Wright, 2000). The cause of muscular dystrophy is unknown. It can cause degenerative changes in the skeletal and esophageal muscles of the pharynx, which may affect the motor function. Patients may have difficulty swallowing. Oculopharyngeal muscular dystrophy is a rare senile disease whose main symptoms are difficulty in hypopharyngeal and progressive drooping of the eyelid. Duranceau et al (1980) reported that 11 patients were treated with UESM incision, 8 patients performed well, and the remaining 3 patients also had different degrees of improvement.

3. Structural changes: idiopathic dysfunction of UESM is a dysfunction of UESM itself. For some patients with oropharyngeal dysphagia who cannot be explained by neurological or muscular diseases, the possibility of this should be considered. Most of the patients are nervous. It is not possible to provide a clear neuropsychological explanation as the basis of the disease. The main manifestations are difficulty in the hypopharynx of the oropharynx, frequent food blockage and multiple aspirations. Patients with ring pharyngeal chambers have difficulty in swallowing, which may be due to poor coordination of UESM, paralysis, loss of relaxation or simply due to the lack of relaxation of UESM. In addition to diverticulectomy, it should be added for UESM incision. Due to the complexity of the structure involved in swallowing, hypopharyngeal disorders may occur after laryngectomy or other throat surgery. Gastroesophageal reflux can be a cause of dysfunction of UESM (Henderson, 1976), which can cause secondary UESM when the reflux reaches the UESM plane.

(two) pathogenesis

The peristalsis of the esophagus begins when the UESM contracts. If a factor causes inconsistency in swallowing activity, or if the pharyngeal muscle contraction is ineffective, the UESM may not fully relax or relax in advance, and dysphagia may occur.

an examination

Related inspection

Esophagography esophageal barium meal perspective

History

Middle-aged women with cerebrovascular disease, or with central nervous system disease and muscle degenerative disease, or a family history of Riley-Dai syndrome.

2. Clinical manifestations

When eating, there are swallowing pain, blockage, foreign body sensation, difficulty swallowing, prolonged meal time; drinking liquid can cause cough. When the food swallows, the neck has a feeling of gas and water.

3. Auxiliary inspection

Barium meal angiography showed dilatation of the esophagus, poor swallowing, and incomplete pharyngeal spasm. Dynamic angiography of the pharynx showed that the row empty time was greatly extended. The motor function detects UESM resting pressure abnormalities, incoordination and relaxation disorders.

Differential diagnosis

1. Suppurative esophagitis: suppurative esophagitis is the most common mechanical damage caused by foreign bodies. Bacteria multiply in the esophageal wall, causing local inflammatory exudation, varying degrees of tissue necrosis and pus formation, and may also be a wide range of cellulitis.

2. Esophageal tuberculosis: Esophageal tuberculosis patients generally have more pioneer symptoms of tuberculosis in other organs, especially the cupping network is tuberculosis. The symptoms of the esophagus itself are often confused or concealed by other organ symptoms, so that they cannot be discovered in time. According to the pathological process of tuberculosis, the early stage of infiltration may have symptoms of fatigue such as fatigue, hypothermia, and increased erythrocyte sedimentation rate, but there are also symptoms that are not obvious. Following swallowing discomfort and progressive dysphagia, often accompanied by persistent throat and retrosternal pain, the cupping net is aggravated when swallowing. Ulcer-type lesions are often characterized by pain during swallowing. Food spills into the trachea should take into account the formation of a tracheal esophageal fistula for a healthy search. Dysphagia suggests that lesion fibrosis causes scarring.

3. Fungal esophagitis: The clinical symptoms of fungal esophagitis are atypical, and some patients may have no clinical symptoms. Common symptoms are swallowing pain, difficulty swallowing, upper abdominal discomfort, post-sternal pain, and burning sensation. In severe cases, there is a knife-like colic behind the sternum, which can radiate to the back like angina. Candida esophagitis can cause severe bleeding but is not common. Untreated patients may have epithelial shedding, perforation, or even disseminated candidiasis. Esophageal perforation can cause mediastinal inflammation, esophageal fistula, and esophageal stricture. Patients with persistent high fever neutropenia should be examined for the presence of disseminated acute candidiasis such as skin, liver, spleen and lung.

4. Viral esophagitis: HSV infection of the esophagus often has nasal and herpes. The main symptom is swallowing pain. Pain often worsens when ingesting food, and the patient descends slowly in the esophagus after swallowing. A small number of patients with dysphagia as the main symptom, mild infection can be asymptomatic.

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