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esophageal atony and paralysis
Last reviewed: 04.07.2025
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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 cannot be systematized in any comprehensive manner. According to some authors, these conditions occur quite rarely, while other authors, on the contrary, claim that dystonic phenomena of the esophagus occur very often, although they are weakly manifested clinically.
Causes esophageal atony and paralysis
The Romanian author S.Surlea (1964) divides this type of pathological conditions of the esophagus into two categories: central (bulbar) and peripheral (secondary) paralysis. Paralysis, the etiology of which is unclear, often goes unnoticed, especially if they are combined with a more clearly defined 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 substance of the brain, gummatous, inflammatory, traumatic, hemorrhagic lesions, manifested by pyramidal, extrapyramidal and bulbar syndromes.
Peripheral paralysis of the esophagus can be the result of diphtheria, viral, zoster polyneuritis, damage to nerve trunks by toxic substances (alcohol, carbon monoxide, narcotics; can occur with toxicosis of pregnancy).
There is an opinion that the considered conditions of the esophagus are related to systemic diseases of the gastrointestinal tract, since they are often combined with diseases such as gastric atony and other intestinal dysfunctions.
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Symptoms esophageal atony and paralysis
The patient's complaints are limited to difficulty swallowing solid food, a feeling of pressure behind the breastbone, and a food bolus getting stuck in the esophagus. Some patients have to make several swallowing movements to swallow a food bolus until it finally gets into the stomach. At first glance, these signs seem to indicate an esophageal spasm, but the probe passes into the stomach without obstruction, and the X-ray shows a significant expansion of the esophageal lumen.
Usually, with mild atony of the esophagus and cuts in its muscles, the general condition of the patient remains satisfactory for a long time. Patients, if the disease does not progress, adapt to the minor phenomena of dysphagia. However, if the phenomena of neuromuscular dysfunction progress, then food intake becomes difficult, patients quickly lose weight, become weaker, they develop anemia, their ability to work decreases, and then the question of using tube feeding arises. In severe irreversible cases, a gastrostomy is applied. It should be noted, however, that in some cases spontaneous recovery occurs, probably due to the disappearance of the cause of esophageal paresis, of course, in the absence of irreversible organic lesions of the neuromuscular apparatus 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 esophageal atony and paralysis
Esophageal paresis or paralysis is diagnosed using esophagoscopy and contrast radiography. Esophagoscopy primarily reveals a significant decrease or absence of reflex activity of the esophagus when in contact with the tube and the absence of peristaltic movements. The lumen of the esophagus is dilated. X-ray examination reveals an extension of the esophageal phase of swallowing, the shadow of the esophagus itself is significantly wider than normal. In case of esophageal atony, as with other neuromuscular dysfunctions of the esophagus, the entire gastrointestinal tract is subject to in-depth examination, since signs of esophageal dysfunction are often part of a systemic gastrointestinal disease.
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Treatment esophageal atony and paralysis
Treatment should be primarily aimed at eliminating the cause of paresis (paralysis, atony, dilation) of the esophagus. Otherwise, symptomatic and, in some cases, pathogenetic treatment is carried out (physiotherapy, general strengthening and tonic agents, adaptogens, multivitamins, etc. Based on the position that dysfunctions of the esophagus are related to a systemic pathological process in the gastrointestinal tract, therapeutic measures are carried out aimed at curing the diseases found in it, and in particular with atony of the stomach. According to indications, strychnine, pilocarpine, metoclopramide, cerucal, stimulants of the motor function of the gastrointestinal tract (Cisapride), etc. are prescribed. The most rational and effective treatment for the specified dysfunctions of the esophagus is carried out in the gastroenterology department with the advisory assistance of a neurologist, whose task is to conduct differential diagnostics, excluding neurogenic causes of paresis or paralysis of the esophagus.
Forecast
The prognosis for the paretic state of the esophagus itself is favorable, but it largely 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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