**6. Vertebral dysfunction and functional disorders of the esophagus**

Vertebrovisceral relations are seldom explored as possible etiological factors of gastrointestinal tract functional disorders. Musculoskeletal changes occur in approximately 60% of patients with functional bowel disorders. Pain of the cervical and upper thoracic spine is often referred to as a focal point in terms of vertebrovisceral relationships. Functional dysphagia represents intermittent problem caused by motility disorders (usually spasm). In a patient group with evidence of spinal and thoracic, cervical dysfunctions and swallowing problems, functional dysphagia was quantified by measuring the dynamic esophageal scintigraphy detected with prolonged passage of marked fluid (Hep et al., 1999).

Disorders of the upper cervical spine are sometimes associated with the emergence of the swallowing difficulty termed globus pharyngicus, which is considered one of the functional disorders. In the past, the relationship between cervical spine disability, dysphonia, and globus formation was described. This relationship is a vertebrovisceral-induced impairment of the spine in the C 1- 4 segments. Globus is a typical syndrome for hyperfunctional dysphonia. Therefore, it is not accurate to designate or consider globus hystericus as a symptom of hysteria (Becker & Aroldo, 1990).

Functional dysphonia is associated with dysfunction of the upper cervical spine. Innervation of the vocal cords through n. laryngeus superior and n. laryngeus recurrens has no relationship with the disability of the spine but cervical spine changes have influence on a number of other muscles and thus affect the relative position of laryngeal cartilage and the tonus of vocal ligaments. They are innervating m. geniohyoideus of segments C1 and C2 (n. hypoglossus), followed by m. omohyoideus, m. sternohyoideus, m. thyreohyoideus, and m.

may also need to be considered in terms of their cumulative impact. As well as those that affect the locomotor system, other factors may be important in terms of their influence on the organism as a whole, for example infections, metabolic disturbances, diet, etc. None of these individual factors on its own would be sufficient to provoke disease but it is legitimate

Motor system statics and dynamics are dependent on the physiological state of central regulatory mechanisms. Pain and stress play important roles. Chronic state pattern and disability severity are not represented with an individual musculoskeletal disorder, and the clinical picture is affected by the patient psychological condition. Vertebrovisceral relations are very complex. In many cases pathogenesis is due to more than one factor, and it is better

In the medical literature the spinal column is mainly mentioned as a cause of dysphagia in the form of a possible mechanical obstacle causing compression of the esophagus by anterior osteophytes: they are believed to produce both dysphagia and dysphonia and even difficulty in breathing (Kodama et al, 1995; Krause & Castro, 1994, Richter et al., 1995; Valadka et al., 1995). Hughes (Hughes et al., 1994) even described patients in whom osteophytes caused dysphagia combined with apnea during sleep. Fuhrmann (Fuhrmann & Neufang, 1994) described similar cases due to disk protrusion. In such cases even surgical treatment was considered. Retropharyngeal hematoma, too, has been described, causing dysphagia and hoarseness (Shaw, 1995). Therefore it is mandatory to have the patient thoroughly examined clinically and by X-ray, ultrasound and esophageal endoscopy, etc.

**6. Vertebral dysfunction and functional disorders of the esophagus** 

Vertebrovisceral relations are seldom explored as possible etiological factors of gastrointestinal tract functional disorders. Musculoskeletal changes occur in approximately 60% of patients with functional bowel disorders. Pain of the cervical and upper thoracic spine is often referred to as a focal point in terms of vertebrovisceral relationships. Functional dysphagia represents intermittent problem caused by motility disorders (usually spasm). In a patient group with evidence of spinal and thoracic, cervical dysfunctions and swallowing problems, functional dysphagia was quantified by measuring the dynamic esophageal scintigraphy detected with prolonged passage of marked fluid (Hep et al., 1999). Disorders of the upper cervical spine are sometimes associated with the emergence of the swallowing difficulty termed globus pharyngicus, which is considered one of the functional disorders. In the past, the relationship between cervical spine disability, dysphonia, and globus formation was described. This relationship is a vertebrovisceral-induced impairment of the spine in the C 1- 4 segments. Globus is a typical syndrome for hyperfunctional dysphonia. Therefore, it is not accurate to designate or consider globus hystericus as a

Functional dysphonia is associated with dysfunction of the upper cervical spine. Innervation of the vocal cords through n. laryngeus superior and n. laryngeus recurrens has no relationship with the disability of the spine but cervical spine changes have influence on a number of other muscles and thus affect the relative position of laryngeal cartilage and the tonus of vocal ligaments. They are innervating m. geniohyoideus of segments C1 and C2 (n. hypoglossus), followed by m. omohyoideus, m. sternohyoideus, m. thyreohyoideus, and m.

to refer to them as risk factors (Lewit 2010).

symptom of hysteria (Becker & Aroldo, 1990).

to speak of disease with vertebrogenic factor (Lewit 2010).

sternothyreoideus, that are innervated mainly from segments C2 and C3. M. cricothyreoideus and m. laryngopharyngeus are also innervated by n. laryngicus cranialis of cervical segments C 1-4. The treatment using musculoskeletal (manual) medicine techniques lead to an improvement of laryngeal difficulties (Hulse, 1991).

Inclusion of functional dysphagia as a vertebrovisceral disorder is generally recognized, but this conditon has not been studied extensively. This is because functional dysphagia borders with four fairly distant branches of medicine—gastroenterology, neurology, otorhinolaryngology, and musculoskeletal medicine. And an objective assessment of this disease is a complicated issue as well.
