Paralysis Of The Esophagus

Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

The passage of liquids and solids through the esophagus is a purely

muscular act, controlled, after the propulsive usually voluntary start

given to the bolus by the inferior constrictor, by a reflex arc having

connection with the central nervous system through the vagus nerve.

Gravity plays little or no part in the act of deglutition, and alone

will not carry food or drink to the stomach. Paralysis of the

esophagus may be said to be motor or sensory. It is rarely if ever

unassociated with like lesions of contiguous organs.

Motor paralysis of the esophagus is first manifested by inability to

swallow. This is associated with the accumulation of secretion in the

pyriform sinuses (the author's sign of esophageal stenosis) which

overflows into the larynx and incites violent coughing. Motor

paralysis may affect the constrictors or the esophageal muscular

fibers or both.

Sensory paralysis of the esophagus by breaking the continuity of the

reflex arc, may so impair the peristaltic movements as to produce

aphagia. The same filling of the pyriform sinuses will be noted, but

as the larynx is usually anesthetic also, it may be that no cough is

produced when secretions overflow into it.

Etiology.--1. Toxic paralysis as in diphtheria.

2. Functional paralysis as in hysteria.

3. Peripheral paralysis from neuritis.

4. Central paralysis, usually of bulbar origin.

Embolism or thrombosis of the posterior cerebral artery is a

reported cause in two cases. Lues is always to be excluded as the

fundamental factor in the groups 3 and 4. Esophageal paralysis is not

uncommon in myasthenia gravis.

Esophagoscopic findings are those of absence of the normal

resistance at the cricopharyngeus, flaccidity and lack of sensation of

the esophageal walls, and perhaps adherence of particles of food to

the folds. The hiatal contraction is usually that normally

encountered, for this is accomplished by the diaphragmatic

musculature. In paralysis of sensation, the reflexes of coughing,

vomiturition and vomiting are obtunded.

Diagnosis.--Hysteria must not be decided upon as the cause of

dysphagia, until after esophagoscopy has eliminated paralysis.

Dysphagia after recent diphtheria should suggest paralysis of the

esophagus. The larynx, lips, tongue, and pharynx also, are usually

paralyzed in esophageal paralysis of bulbar origin. The absence of the

cricopharyngeal resistance to the esophagoscope passed without

anesthesia, general or local, is diagnostic.

Treatment.--The internist and neurologist should govern the basic

treatment. Nutrition can be maintained by feeding with the

stomach-tube, which meets no resistance to its passage. Should this be

contraindicated by ulceration of the esophagus, gastrostomy should be