Food stagnation and esophageal dysmotility in MSA

Recently, there was a Japanese study published in Dysphagia (a journal) comparing esophageal involvement in MSA and ALS.  They investigated something called “food stagnation,” which I’m assuming is where food gets stuck in the esophagus.  Researchers looked at 16 MSA patients with dysphagia and 16 ALS patients with dysphagia.

The paper wasn’t really about treatment but more about the need to use videofluorography to analyze the esophageal phase in those with MSA (or ALS) to see how severe food stagnation is.  In this small study, food stagnation occurred in 100% of the MSA patients.  It was only present in 25% of the ALS group.  Aspiration pneumonia and sudden death are concerns.  I think sudden death is due to suffocation on regurgitated food.

Those with MSA are warned not to lie down right after eating.  And the researchers expressed some concern that CPAP machines may exacerbate food regurgitation.  They note that this concern is “purely speculative.”

I’ve copied the abstract below.

Someone on the ShyDrager Yahoo!Group had asked about “esophageal dysmotility.”  While I was looking up a definition of that term, I stumbled across a useful website called  They have a good webpage on esophageal dysmotility:

There was a short paragraph about treatment:

“Dysmotility disorders of the esophagus are generally incurable. The main objective of treatment is therefore symptom management and relief. Several types of medication can be used for dysmotility treatment, including calcium channel blockers and botulinum toxin. Dietary modifications can help relieve symptoms, and some disorders can be improved with surgery.”

I posted some of this info on the ShyDrager Yahoo!Group.  One of our local BSN group members, Don, posted that his wife was harmed by botox injections.  She received injections in the salivary glands to treat excess salivation.  As a result, her swallowing went “from difficult to impossible.”  She had to be hospitalized and came home with a feeding tube.  Don notes that this does not happen to everyone.  Indeed, we’ve had many group members who have received botox injections for drooling to no ill effect.  But it’s certainly a risk.




Dysphagia. 2015 Jul 24.

Esophageal Involvement in Multiple System Atrophy.
Taniguchi H, Nakayama H, Hori K, Nishizawa M, Inoue M, Shimohata T.

The prevalence of esophageal involvement and its impact on clinical manifestations in patients with multiple system atrophy (MSA) remains unknown. We recruited 16 consecutive patients with dysphagia associated with MSA (MSA group) and 16 consecutive patients with dysphagia associated with amyotrophic lateral sclerosis (ALS group). We assessed the presence or absence of food stagnation within the esophagus using videofluorography. Food stagnation within the esophagus was observed in 16 patients (100 %; 7 severe, 9 mild) in the MSA group and in 4 patients (25 %; 4 mild) in the ALS group (P < 0.001). Follow-up videofluorography revealed that food stagnation in patients with MSA could exacerbate during the disease course. Patients with MSA and severe food stagnation showed a wide range of intraesophageal stasis by videofluorography. Among the 16 patients in the MSA group, 4 developed aspiration pneumonia and 1 died of suffocation associated with food regurgitation during continuous positive airway pressure therapy. In conclusion, food stagnation within the esophagus occurs more frequently in MSA patients with dysphagia than in ALS patients with dysphagia. Because food stagnation can cause serious complications such as aspiration pneumonia and suffocation, patients with MSA should be evaluated by videofluorography, especially those with stagnation in the esophageal phase.

PMID:  26205436