Spasms of the esophagus

Neuromuscular dysfunction of the esophagus - functional diseases, which are based on the violation of its motor function, due to various causes (psychoemotional stress, hysteria, organic diseases of the corresponding stem centers regulating the motor function of the esophagus, endocrine and metabolic disorders, etc.). Neuromuscular dysfunction of the esophagus includes spastic and paretic syndromes.

Spasms of the esophagus refer to parakinetic disorders of the motor function of this organ, caused by toxic, microbial and viral neuritis innervating its nerves, as well as meningoencephalitis of a similar nature. Spasm of the esophagus can arise as a pathological viscero-visceral reflex caused by the presence of a pathological focus near the esophagus, or as a result of factors such as microtrauma, tachyphagia, the use of strong alcoholic beverages, excessively dense or hot food, stuck in the esophagus of a foreign body. As a rule, spasm of the esophagus occurs either at its entrance or at the end, ie, in the region of its upper or lower sphincters, where the innervation of the musculature is particularly rich. They can be mild and transient, acute and chronic, occurring only in the sphincter region or touching the entire esophagus. The latter is a rare phenomenon, manifested by a tonic contraction of the whole musculature of the esophagus.

Spasms of esophageal sphincters are most common in women between the ages of 18 and 35 years, common esophagus spasms are equally common in both sexes after 45 years. Initially, the spastic syndrome of the esophagus is of a functional nature and can undergo sufficiently long periods of remission, especially when carrying out measures to eliminate its underlying cause. With prolonged and persistent spasms of the esophagus, functional phenomena are transformed into organic changes in those places where spastic phenomena are especially long-lasting. These changes, especially often occurring in the region of the superior esophageal sphincter, include interstitial fibrosis, degenerative myositis and structural changes in the neuromuscular apparatus of the esophageal wall and the corresponding nerve nodes. Organic changes in nonspecific spasms and prolonged functional dyskinesias are characterized by diffuse nodular myomatosis.

[1], [2], [3]

Spasm of upper esophageal narrowing

Spasm of the upper narrowing of the esophagus is the most frequent manifestation of neuromuscular dysfunction of the esophagus, which occurs in persons with increased emotional lability, neurotics and hysteroid individuals. Spasm of the esophagus often occurs during eating. Patients complain of an unpleasant sensation behind the sternum, a feeling of raspiraniya in the chest, a lack of inhaled air; cough, nausea, face hyperemia, anxiety and other phenomena associated with anxiety and fear.

Acute spasm can last several hours and even days. Spasm occurs suddenly or is established gradually with an irregular frequency, amidst complete rest or after some kind of nervous tension. This position keeps the patient in constant fear, which in itself can serve as a trigger mechanism for spasm. Constant fears of the patient force him to use insufficiently energetic food, to eat irregularly, to resort only to the intake of liquids, which ultimately negatively affects the general state of the patient and leads to his weakening and weight loss.

In radiography, the contrast of the contrast agent is detected at the level of the cricoid cartilage, and with esophagoscopy, there is a marked spasm of the esophagus in the region of its upper aperture, the passage through which the fibroscope is possible only after a prolonged application of anesthesia of the mucous membrane.

Chronic spasm usually occurs in adults with tachyphagia, with reduced chewing efficiency of the teeth, with various defects of the dentoalveolar apparatus, in neuropaths who have had episodes of acute esophageal spasm in the anamnesis. Such patients complain of a feeling of discomfort in the upper parts of the esophagus, poor patency during a meal of a dense consistency, the need to drink every sip of water or warm tea. Food intake is becoming more and more difficult; in the end, over the site of chronic spasm develops an esophagus, which manifests itself by the appearance of swelling in the neck. When radiographing with contrast, a contrast agent is detected over the spasm zone, and in the presence of esophageal expansion, its accumulation in the formed cavity. When esophagoscopy is determined hyperemia of the mucous membrane over the spasm zone, which in this area is covered by leukocyte deposit, and the entrance to the esophagus is either spasmodic, or deformed as a result of developing sclerotic phenomena in its wall.

Diagnosis and treatment

The diagnosis is not always easy to establish, a detailed examination of the patient is necessary to exclude the tumor.

Diagnosis of functional esophageal spasm is established only after it is ascertained that this spasm is not caused by mechanical damage to its wall or by the presence of a foreign body.

Treatment consists in long-term bougie and application of general measures depending on the causes of the disease.

[4], [5]

Spasm of the lower part of the esophagus

Spasm of the lower part of the esophagus is also acute and chronic.

Acute spasm is more often associated with spasm of entering the esophagus and is localized in the field of cardia. Isolated spasm of the latter manifests itself in pain in the depth of the epigastric region or behind the breastbone. During the meal, the patient has a feeling of stopping food over the stomach, and attempts to move the food lump further with a sip of fluid remain unsuccessful. When esophagoscopy is established, the presence of a hardly passable spasm in the area of narrowing of the esophagus or food slump, if before the food masses were not ejaculated by vomiting. The mucous membrane above the spastic site is almost normal.

Treatment

Eliminate acute spasm can be achieved with the help of several bougiers, but if not to eliminate the main cause of it, then it can periodically recur, passing gradually into chronic.

Spasms of the esophagus along the course

Spasms of the esophagus along the extension (nonspinicular) can arise in different parts of the esophagus, as if on its different floors. This condition of etched spasms was described in the first quarter of the 20th century. Renhenologami - Hungarian I. Barshoni and German V. Tischendorf and was called the syndrome Barshonya - Tischendorf. This syndrome is characterized by ring-shaped spasms of the esophagus, painful intermittent swallowing difficulties, lasting from several minutes to several weeks, regurgitation of mucus, severe pain behind the sternum. All these phenomena are accompanied by a sharply increased appetite, often combined with a duodenal ulcer or stomach, gallstone disease. When fluoroscopy during an attack, multiple segmental spasms of the esophagus are revealed. The syndrome manifests itself usually after 60 years.

Treatment

Treatment is carried out in the order of emergency assistance by intramuscular or intravenous administration of atropine. This technique can also be used as a diagnostic test: the disappearance of spasm after 1 h after injection and its resumption in 2 h indicates the functional nature of the obstruction of the esophagus.

Spasms of the esophagus in children

Spasms of the esophagus in children - a rare phenomenon, manifested depending on the duration of spasm short or prolonged dysphagia. Periodic (intermittent) dysphagia in an infant appears during the first weeks of feeding regurgitation of liquid food mixed with saliva without any signs of gastric fermentation. The child's body weight quickly decreases, but when fed through the catheter is restored, the child quickly gets used to this method of nutrition. When esophagoscopy is easy to determine the location of spasm; The mucosa has a pink coloration without any other signs of injury. When fluoroscopy in the esophagus an air bubble is detected.

In the older age, esophageal spasm arises in children easily excitable with various functional disorders of the nervous system and manifests itself without any effort of regurgitation of the food immediately after its ingestion. As a special feature of spasm of the esophagus in children of this age, it should be noted that in some of them, dysphagia is more pronounced when receiving liquid food.

Attacks of dysphagia evolve, becoming more frequent and prolonged, which affects the nutrition and general condition of the child. When there is a spasm in the area of the entrance to the esophagus, a Weil symptom arises, characterized by a lack of food in the esophagus when it attempts to swallow it and a pronounced phenomenon of dysphagia. Spasm of the esophagus can be localized in the middle section or in the area of the cardia. In the latter case, with repeated spasms, a permanent contracture with retrograde esophagus expansion develops here. Constant dysphagia with spasm of the esophagus is observed only in older children, in whom vomiting and regurgitation occur daily. Children weaken, lose weight, become more susceptible to childhood infections.

The causes of spasm of the esophagus in children include the structure of the mucosa of the esophagus, the increased sensitivity of the nerves of its smooth muscles, any local factors serving as trigger mechanisms for provoking a spasm, for example a congenital anatomical feature or convulsive alertness or a lower threshold for paroxysmal activity in spasmophilia , which occurs in patients with rickets in the first 6-18 months of life, characterized by signs of increased neuromuscular excitability with prone to spasms and convulsions, occurs in the disorder of calcium and phosphorus metabolism), tetany of various genesis in young children, including tetany, which occurs when intestinal absorption is impaired, parafyroid gland hypothyroidism, kidney disease, etc.

Treatment

Treatment is aimed at eliminating the underlying cause of convulsive syndrome and is conducted under the supervision of a pediatric neurologist.