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Paralysis Of The EsophagusCategory: DISEASES OF THE ESOPHAGUS Source: 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 done. Next: Lues Of The Esophagus Previous: Diverticulum Of The Esophagus
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