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Atony and paralysis of the esophagus
Last reviewed: 23.04.2024
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Atony and paralysis of the esophagus are conditions characterized by functional disorders of the neuromuscular apparatus of the esophagus, the causes of which are so numerous that they do not lend themselves to any complete systematization. In the opinion of some authors, these conditions occur rather rarely, while other authors, on the contrary, argue that the dystonic phenomena of the esophagus occur very often, although they are clinically weak.
Causes of the atony and paralysis of the esophagus
The Romanian author S.Surlea (1964) subdivides this type of pathological conditions of the esophagus into two categories: central (bulbar) and peripheral (secondary) paralysis. Paralysis, the etiology of which is not clear, often go unnoticed, especially if they are combined with a more distinctly outlined clinical picture of diseases of the pharynx, larynx, trachea, etc., which mask functional disorders of the esophagus.
Central paralysis of the esophagus can occur with destructive changes in the brain substance, gum, inflammatory, traumatic, hemorrhagic lesions manifested by pyramidal, extrapyramidal and bulbar syndromes.
Peripheral paralysis of the esophagus may result from diphtheria, viral, zoster polyneuritis, damage to nerve trunks by toxic substances (alcohol, carbon oxide, narcotic drugs, may occur with toxicosis of pregnant women).
There is an opinion that the esophagus conditions considered refer to systemic GI diseases, as they are often combined with such diseases as atony of the stomach and other intestinal dysfunctions.
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Symptoms of the atony and paralysis of the esophagus
Complaints of the patient are reduced to difficulty when swallowing dense food, feeling the pressure behind the sternum and getting stuck with the food lump in the esophagus. Some patients, in order to swallow a food lump, are forced to do several swallowing movements, so that it finally enters the stomach. At first glance, these signs seem to indicate a spasm of the esophagus, but the probe passes unhindered into the stomach, and on the roentgenogram a significant expansion of the lumen of the esophagus is revealed.
Usually, with unexposed atony of the esophagus and cuts in his musculature, the general condition of the patient remains long satisfactory. Patients, if the disease does not progress, adapt to the minor dysphagia that occurs. However, if the phenomena of neuromuscular dysfunction progress, then eating becomes difficult, patients quickly lose weight, weaken, they develop anemia, reduced ability to work, and then the question arises about the use of probe nutrition. In severe cases irreversible impose gastrostomy. It should be noted, however, that in some cases spontaneous recovery occurs, probably due to the disappearance of the cause of the esophagus paresis, of course, in the absence of irreversible organic lesions of the neuromuscular system and the muscular layer of the esophagus (sclerosis, fibrosis). In the latter case, the motor function of the esophagus is reduced to a minimum or stops altogether.
Diagnostics of the atony and paralysis of the esophagus
The diagnosis of paresis or paralysis of the esophagus is established with the help of esophagoscopy and radiography with contrasting. Esophagoscopy first of all strikes a significant decrease or absent reflex activity of the esophagus when it comes into contact with the tube and the absence of peristaltic movements. The lumen of the esophagus is enlarged. When fluoroscopy reveals an elongation of the esophageal phase of swallowing, the shadow of the esophagus is much wider than normal. When atony of the esophagus, as in other neuromuscular dysfunctions of the esophagus, the whole gastrointestinal tract is subjected to in-depth examination, since often the signs of esophageal dysfunction are part of the systemic GI disease.
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Treatment of the atony and paralysis of the esophagus
Treatment should primarily be aimed at eliminating the cause of paresis (paralysis, atony, dilatation) of the esophagus. The rest is symptomatic and in some cases pathogenetic treatment (FTL, restorative and tonic, adaptogens, multivitamins, etc. Based on the thesis that the disorders of the esophagus are related to the systemic pathological process in the digestive tract, they carry out therapeutic measures aimed at curing It is indicated by strychnine, pilocarpine, metoclopramide, cerucal, stimulants of the motor function of the gastrointestinal tract (Cisapride), etc. The most rational th and effective treatment of these dysfunctions esophagus performed on gastroenterological department with the advice of the neurologist, the task of which lies in the differential diagnosis, excluding neurogenic causes paresis or paralysis of the esophagus.
Forecast
The prognosis of the actual paretic state of the esophagus is favorable, but in many respects it depends on the cause that caused it, especially if these causes are due to organic lesions of the central nervous system.
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