Esophageal spasms

Neuromuscular dysfunctions of the esophagus are functional diseases based on a disorder of its motor function caused by various reasons (psychoemotional stress, hysteria, organic diseases of the corresponding stem centers regulating the motor function of the esophagus, endocrine and metabolic disorders, etc.). Neuromuscular dysfunctions of the esophagus include spastic and paretic syndromes.

Esophageal spasms are parakinetic disorders of the motor function of this organ caused by toxic, microbial and viral neuritis of the nerves innervating it, as well as meningoencephalitis of a similar nature. Esophageal spasm may occur 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, consumption of strong alcoholic beverages, excessively dense or hot food, or a foreign body getting stuck in the esophagus. As a rule, esophageal spasm occurs either at its entrance or at the end, i.e. in the area of its upper or lower sphincters, where the innervation of the muscles is especially rich. They can be mild and transient, acute and chronic, occurring only in the area of the sphincters or affecting the entire esophagus. The latter is a rare phenomenon, manifested by a tonic contraction of the entire musculature of the esophagus.

Esophageal sphincter spasms are most common in women aged between 18 and 35 years; general esophageal spasms are equally common in both sexes after 45 years. Initially, the spastic syndrome of the esophagus is functional in nature and may undergo fairly long periods of remission, especially when measures are taken to eliminate its underlying cause. With prolonged and constant spasms of the esophagus, functional phenomena are transformed into organic changes in those places where spastic phenomena are observed for a particularly long time. These changes, which are especially common in the area of the upper 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 non-sphincteric spasms and prolonged functional dyskinesias are characterized by diffuse nodular myomatosis.

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Spasm of the upper esophageal stenosis

Spasm of the upper esophageal stenosis is the most common manifestation of neuromuscular dysfunction of the esophagus, occurring in individuals with increased emotional lability, neurotics and hysterical personalities. Esophageal spasm most often occurs during meals. Patients complain of an unpleasant sensation behind the sternum, a feeling of distension in the chest, lack of inhaled air; cough, nausea, facial hyperemia, anxiety and other phenomena associated with excitement and fear.

An acute spasm can last for several hours or even days. The spasm occurs suddenly or is established gradually with irregular frequency, in the midst of complete rest or after some nervous tension. Such a situation keeps the patient in constant fear, which in itself can serve as a trigger for the spasm. The patient's constant fears force him to eat insufficiently energetic food, eat irregularly, resort to taking only liquids, which ultimately has a negative effect on the general condition of the patient and leads to his weakening and weight loss.

Radiography reveals a delay in the contrast agent at the level of the cricoid cartilage, and esophagoscopy reveals a pronounced spasm of the esophagus in the area of its upper opening, through which the fibroscope can only pass after prolonged application anesthesia of the mucous membrane.

Chronic spasm usually occurs in adults with tachyphagia, with reduced chewing efficiency of teeth, with various defects of the dental apparatus, in neuropaths who have had attacks of acute esophageal spasm in their anamnesis. Such patients complain of a feeling of discomfort in the upper sections of the esophagus, poor patency during the intake of food of a dense consistency, the need to wash down each sip with water or warm tea. Eating becomes more and more difficult; eventually, over the area of chronic spasm, dilation of the esophagus develops, which is manifested by the appearance of swelling in the neck. Radiography with contrast reveals a delay in the contrast agent over the spasm zone, and in the presence of esophageal dilation - its accumulation in the formed cavity. Esophagoscopy reveals hyperemia of the mucous membrane above the spasm zone, which in this area is covered with a leukocyte coating, 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 required to rule out a tumor.

The diagnosis of functional spasm of the esophagus is established only after it is confirmed that this spasm is not caused by mechanical damage to its wall or the presence of a foreign body.

Treatment consists of long-term probing and the use of general measures depending on the causes of the disease.

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Lower esophageal spasm

Spasm of the lower esophagus can also be acute and chronic.

Acute spasm is more often associated with spasm of the entrance to the esophagus and is localized in the area of the cardia. Isolated spasm of the latter is manifested by pain in the depth of the epigastric region or behind the sternum. During a meal, the patient experiences a sensation of food stopping above the stomach, and attempts to move the food bolus further by swallowing liquid remain unsuccessful. Esophagoscopy establishes the presence of a difficult-to-pass spasm in the area of esophageal narrowing or food blockage, if the food masses have not been ejected by vomiting before. The mucous membrane above the spastic area is practically normal.

Treatment

Acute spasm can be eliminated with the help of several bougienages, however, if the underlying cause is not eliminated, it can recur periodically, gradually becoming chronic.

Esophageal spasms along the length

Esophageal spasms along the length (non-sphincteric) can occur in different parts of the esophagus, as if on its different floors. This condition of floored spasms was described in the first quarter of the 20th century by radiologists - Hungarian I. Barsony and German W. Tischendorf and was called the Barsony-Tischendorf syndrome. This syndrome is characterized by ring-shaped spasms of the esophagus, painful intermittent swallowing difficulties lasting from several minutes to several weeks, mucus regurgitation, severe pain behind the breastbone. All these phenomena are accompanied by a sharply increased appetite, often combined with a duodenal ulcer or stomach ulcer, cholelithiasis. X-ray examination during an attack reveals multiple segmental spasms of the esophagus. The syndrome usually manifests itself after 60 years.

Treatment

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

Esophageal spasms in children

Esophageal spasms in children are rare, manifesting themselves, depending on the duration of the spasm, as short or long-term dysphagia. Periodic (intermittent) dysphagia in an infant manifests itself in the first weeks of feeding by regurgitation of liquid food mixed with saliva without any signs of gastric fermentation. The child's body weight decreases rapidly, but is restored with catheter feeding, and the child quickly gets used to this method of feeding. Esophagoscopy easily determines the localization of the spasm; the mucous membrane is pink without any other signs of damage. X-ray examination reveals an air bubble in the esophagus.

At an older age, esophageal spasm occurs in easily excitable children with various functional disorders of the nervous system and is manifested by regurgitation of food immediately after swallowing, which occurs without any effort. As a feature of esophageal spasm in children of this age, it should be noted that in some of them, dysphagia is more pronounced when taking liquid food.

Attacks of dysphagia evolve, becoming more frequent and prolonged, which affects the child's nutrition and general condition. When a spasm occurs in the area of the entrance to the esophagus, Weil's symptom occurs, characterized by the failure of food to enter the esophagus when trying to swallow it and a pronounced phenomenon of dysphagia. Esophageal spasm 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 expansion of the esophagus develops here. Permanent dysphagia with esophageal spasm is observed only in older children who experience vomiting and regurgitation daily. Children become weaker, lose weight, and become more susceptible to childhood infections.

Causes of esophageal spasm in children include structural features of the esophageal mucosa, increased sensitivity of the nerves of its smooth muscles, any local factors that serve as trigger mechanisms for provoking spasm, such as a congenital anatomical feature or convulsive readiness or a decrease in the threshold of paroxysmal activity in spasmophilia (a pathological condition that occurs in children with rickets in the first 6-18 months of life; characterized by signs of increased neuromuscular excitability with a tendency to spasms and convulsions; occurs with a disorder of calcium and phosphorus metabolism), tetany of various origins in young children, including tetany that occurs with impaired intestinal absorption, hypofunction of the parathyroid glands, kidney disease, etc.

Treatment

Treatment is aimed at eliminating the underlying cause of the seizure syndrome and is carried out under the supervision of a pediatric neurologist.