Swallowing problems. Bulbar palsy

Achalasia is a disease entity in its own right, with spasm of the valve at the bottom of the oesophagus and failure of the normal rhythmic peristalsis of the oesophagus
The swallowing problems in GBS/CIDP are due to bulbar palsy.
Bulbar palsy results from bilateral impairment of function of the IXth, Xth and XIIth cranial nerves. This gives rise to dysarthria (difficulty speaking), dysphagia (difficulty swallowing often with choking episodes and nasal regurgitation of fluids), dysphonia (hoarsenes or voice change) and poor cough reflex, and susceptibility to aspiration pneumonia. The lowermost part of VII may, infrequently, be involved.

The disturbance is of the motor nuclei rather than of the corticobulbar (brain to brain stem) tracts. It is distinguished from pseudobulbar palsy by the presence of lower motor neurone signs. Autonomic features are uncommon. DocDavid