Dyskinesia of the esophagus

Dyskinesia of the esophagus is a violation of its motor (motor) function, consisting in changing the progress of food from the pharyngeal cavity to the stomach in the absence of organic lesions of the esophagus.

Disturbances in the motor function of the esophagus lead either to a delay or slowing the progress of food antegrade, or to the appearance of retrograde movement.

[1], [2], [3]

Classification of esophagus dyskinesia

I. Violations of the peristalsis of the thoracic esophagus

1. Hypermotor

• Segmental esophagospasm (the "esophagus of the nutcracker")
• Diffuse esophagospasm
• Nonspecific movement disorders

2. Hypomotor

II. Disorders of the sphincter

1. Lower esophageal sphincter

Lack of cardia:

• Gastroesophageal reflux disease
• Achalasia cardia
• Cardiospasm

2. Upper esophageal sphincter

[4], [5]

Hypermotor disorders of the peristalsis of the thoracic esophagus

Hypermotor dyskinesia of the thoracic esophagus is characterized by an increase in its tone and motor function, and this can be observed not only during ingestion of food, but also outside the swallowing act. Approximately 10% of patients with symptomatic disease may not be (latent flow). To diagnose in this case, hypermotor dyskinesia of the esophagus can be based on fluoroscopy of the esophagus, and also by esophageal manometry .

The main symptoms of hypermotor dyskinesia of the thoracic esophagus are:

• dysphagia - difficulty swallowing. It is characteristic that dysphagia is impermanent, during the day it can appear and disappear again, may be absent for several days, weeks, months and again appear. Dysphagia can be provoked by smoking, too hot or too cold food, sharp spices and sauces, alcohol, psychoemotional stressful situations;
• chest pains - arise suddenly, are quite intense, can radiate to the left arm, scapula, half of the thorax and, of course, require differential diagnosis with ischemic heart disease. Unlike IHD, there is no connection with physical activity and there are no ischemic changes in the ECG;
• sensation of "lump in the throat" - occurs when spasms of the initial parts of the esophagus and is observed more often with neuroses and hysteria;
• serration of the esophagus contours, local deformation and retention of contrast mass in any part of the esophagus more than 5 s (with fluoroscopy of the esophagus).

Segmental esophagospasm (the "esophagus of the nutcracker")

With this variant of esophageal dyskinesia spasm of limited areas of the esophagus is observed. The main symptoms are:

• dysphagia - is characterized primarily by the difficulty of the passage of semi-liquid food (sour cream, wiped cottage cheese) and rich in fiber (fresh fruit, vegetables), dysphagia can occur when consuming juices;
• pain of moderate intensity in the middle and lower third of the sternum without irradiation begin and stop gradually;
• spasm of restricted areas of the esophagus;
• spastic contractions of the limited sections of the walls of the esophagus lasting longer than 15 s with an amplitude of 16-18 mm Hg. (according to the data of the esophagothicography)

Diffuse esophagospasm

Characteristic manifestations of diffuse esophagospasm are:

• extremely severe pain in the sternum or epigastrium, rapidly spreading upward, as well as irradiating on the front surface of the chest, in the lower jaw, shoulders. The pains occur suddenly, often associated with swallowing, last long (from half an hour to several hours), in some patients may disappear after a sip of water. Pain is caused by prolonged non-peristaltic contractions of the thoracic esophagus;
• paradoxical dysphagia - difficulty swallowing expressed more when swallowing liquid food and lessreception of solid food. Dysphagia can become daily or appear 1-2 times a week, sometimes 1-2 times a month;
• pain at the end of the attack;
• prolonged and prolonged (more than 15 s) spasm of the esophagus wall (with fluoroscopy of the esophagus);
• spontaneous (not associated with swallowing) reduction in the wall of the esophagus of high amplitude (more than 40-80 mm Hg) at a distance of more than 3 cm from each other (according to the data of esophagothicography).

[6]

Nonspecific motor disorders of the esophagus

Nonspecific violations of the motor function of the esophagus occur against the background of its preserved peristalsis.

The main symptoms are as follows:

• periodic occurrence of pain in the upper middle third of the sternum of varying intensity, usually during eating, swallowing, and not spontaneously. Typically, the pain is not long, can go on independently or after taking antacids or a sip of water;
• Dysphagia is rare.

With fluoroscopy, one can observe non-impulsive non-hyperstatic contractions of the esophageal wall that arise when swallowing.

Hypermotor dyskinesia of the esophagus must be differentiated first of all with esophagus cancer, cardiac achalasia, gastroesophageal reflux disease and coronary artery disease. To determine the exact diagnosis, use is made of fluoroscopy of the esophagus, esophagoscopy, pH-metry and esophagus manometry, a test with the introduction of hydrochloric acid into the esophagus , a grinding test with inflation in the esophagus of a rubber canister under esophagothoimagrafic, X-ray, electrocardiographic control (test provokes the appearance of hypermotor dyskinesia of the esophagus).

Hypomotor disorders of the peristalsis of the thoracic esophagus

Primary hypomotor disorders of peristalsis of the esophagus are rare, mainly in elderly and senile patients and chronic alcoholics. They may be accompanied by a deficiency of cardia and play a role in the development of reflux esophagitis.

About 20% of patients with hypomotor dyskinesia of the esophagus do not complain. The remaining patients may have the following manifestations of the disease:

• dysphagia;
• regurgitation;
• feeling of heaviness in the epigastrium after eating;
• Aspiration of the contents of the esophagus (stomach) into the respiratory tract and development of chronic bronchitis, pneumonia;
• esophagitis ;
• decrease in pressure in the esophagus, in the region of the lower esophageal sphincter (with esophagotho-kymographic examination).

Cardiospasm

Cardiospasm is the spastic reduction of the lower esophageal sphincter. In the literature there is still no consensus on the terminology of this disease. Many identify him with achalasia of the cardia. Famous specialists in the field of gastroenterology AL Grebenev and VM Nechaev (1995) consider cardiopathism as a rather rare type of esophagus and do not equate cardiac spasm and cardiac achalasia.

In the initial stages of the disease, the clinical picture clearly shows psychosomatic manifestations in the form of irritability, emotional lability, tearfulness, memory loss, palpitations. Along with this, patients complain of a sensation of a "lump" in the throat, a difficulty in passing food through a food festival ("food gets stuck in the throat"). In the future, the sensation of a foreign body in the esophagus disturbs the patients not only during meals, but also outside eating, especially during excitement. Very often, patients refuse food because of fear of intensifying these sensations. Dysphagia is often accompanied by increased respiration, complaints of lack of air. If there is a significant increase in the rate of breathing, it is possible to eat food.

As a rule, along with the dysphagia of patients, the burning sensation and pains of the sternum in the middle and lower third, the interblade area, are disturbed.

Dysphagia and pain behind the breastbone are easily provoked by a mental trauma, psycho-emotional stressful situations.

Pain, like dysphagia, can be associated with food intake, but often arise independently of food and sometimes reach the intensity of a painful crisis.

Frequent heartburn, belching of air, eaten food. These symptoms can be caused by hyperkinesia and hypertension of the stomach.

With a sharply expressed clinic of cardiopathism, a significant weight loss of the patient is observed, as patients are few and rarely eat due to fear of increased pain.

Diagnosis of cardiac spasm is facilitated by fluoroscopy of the esophagus. In this case, a spasm of the lower esophageal sphincter is revealed. On the roentgenogram of the esophagus, its outlines become wavy, with contours on its contours.

[7]

Achalasia cardia

Akhalasia cardia is a neuromuscular disease of the esophagus, consisting in a persistent violation of the cardiac dilatation reflex when swallowing and the appearance of dyskinesia of the thoracic esophagus.

[8], [9]