Esophageal Dysmotility is Common in Patients With Multiple System Atrophy

Abstract

Objectives: Esophageal dysmotility (ED) in patients with multiple system atrophy (MSA) are poorly understood. This study aimed to investigate the prevalence of ED in patients with MSA and to assess the relationship of esophageal abnormalities with other clinical findings and characteristics in these patients. Methods: A retrospective chart review was conducted to identify patients with MSA and to compare them to the elderly controls without MSA (65+ years) who underwent a videofluorographic esophagram from 2014 to 2019. Disease type, disease severity, vocal fold mobility impairment, abnormal deglutitive proximal esophageal contraction (ADPEC), and intra-esophageal stasis (IES) were reviewed and compared between groups. Results: Thirty-seven patients with MSA were identified. The median age was 63 and 26 (70%) were male. These patients were matched to 22 elderly adults with presbylarynx but not MSA (median age 77, 68% male). In MSA patients, cerebellar variant type was predominant (59%), and ADPEC was recognized in 18 patients (49%). Disease severity level (P = 0.028) and existence of IES (P = 0.046) were associated with higher risks of developing ADPEC. The prevalence of IES was significantly higher in patients with MSA (95%) compared to controls without MSA (46%) (P < 0.001). Disease severity level and the existence of IES were significantly associated with the presence of ADPEC (p < 0.05). Conclusion: ADPEC and IES were significantly more common in MSA than in elderly subjects without MSA. MSA severity is associated with the development of ADPEC. The data suggest that esophageal motility is predominantly affected in MSA.

Distal oesophageal spasm in a patient with multiple system atrophy: A case report

“…We identified DES as an oesophageal dysfunction in a patient with MSA, using high-resolution oesophageal manometry. Previous studies of MSA demonstrated oesophageal dysfunction, including incomplete relaxation of the UES during swallowing 3 , abnormal UES resting pressure, abnormal deglutitive proximal oesophageal contraction [ 7 , 8 ], and oesophageal hypomotility [ 2 ]. Although most studies have focused on upper oesophageal dysfunction, we identified DES by evaluating the entire oesophagus.…”

Clinical Risk Factors for Dysphagia and Esophageal Dysmotility in Systemic Sclerosis

“…The comparative value was calculated by dividing the diameter of the esophagus after esophageal contraction by the maximally dilated esophageal diameter, and an ED grade of 0 was defined as a value of 20% or less, grade 1 as 20-50% value, grade 2 as 50-80% value, and grade 3 as value of 80% or more (Figure 1A). The esophagus, as visualized fluoroscopically, was anatomically divided into three sections based on a revised classification of previous reports [19,20]: (1) cervical esophagus: proximal to the clavicles, (2) upper thoracic esophagus: from the clavicles distal to the tracheal bifurcation, and (3) mid-lower thoracic esophagus: from the tracheal bifurcation to the lower esophageal sphincter. ED grade was evaluated at these locations, and the ED score was defined as the sum of the ED grades at the three sites (Figure 1B).…”

“…ED grade was evaluated at these locations, and the ED score was defined as the sum of the ED grades at the three sites (Figure 1B). Herein, an ED score ≥ 3 was defined as having apparent esophageal dysmotility, since even healthy elderly patients without esophageal symptoms have mild esophageal dysmotility (ED score 1-2) [20]. The PAS and ED scores were evaluated based on a consensus between two otolaryngologists with at least 10 years of experience.…”

Characteristics of Japanese patients with systemic sclerosis with dysphagia: a single-center study

“…Esophageal peristalsis is originally evaluated by decreasing the velocity of the contrast medium through the esophagus and re ecting the residue of the contrast medium in the esophagus 22 . In order to evaluate lower esophageal peristalsis in SSc, we divided the lower esophagus into three parts (lower thoracic esophagus, middle thoracic esophagus, and upper thoracic esophagus or higher) based on previous studies 23 . In the esophageal phase, scales were de ned as follows; "0: none" grade represents no residue; "1: mild" means less than half of lower esophageal sphincter (LES) to tracheal bifurcation; "2: moderate" means more than half of LES to tracheal bifurcation; "3: severe" means above the tracheal bifurcation.…”