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Disturbance of a tone of a gullet

Disturbance of a tone of a gullet is characterized by lowering or increase of a tone of all gullet or its separate parts, and also a simultaneous combination of hypotonia of one and a spasm of other (fig. 1). At the lowered tone moderately expressed expansion of a gleam of a gullet, delay of passability of a contrast agent, long stretching and slow fall of walls, a gleam gaping is defined.

Нарушение тонуса пищевода
Fig. 1. Disturbance of a tone of a gullet:
1 — the expressed expansion of a gleam: lengthening, curvature of a gullet, sharp disturbance of passability; 2 — expansion of a gleam with a segmented spasm in chest and belly parts of a gullet.

Increase of a tone of a gullet is characterized by such diverse signs as secondary, atypical reductions, an esophagism, etc.
Secondary atypical reductions in chest part of a gullet extend in the distal and proximal directions. These short-term reductions appear when passing a contrast agent in the form of circular banners of a gullet then the gullet takes the usual taenioid form with equal contours.
Tertiary reductions (floor-by-floor or segmented spasm, pseudo-diverticulums, shtoporoobrazny gullet) represent a series of quickly replaced reductions after primary vermicular movement and cover 2\3-3\4 gullets. At the same time contours of a gullet become uneven, ledges in the form of beads alternate with retractions.
The achalasia — lack of relaxation of esophageal and gastric transition — is one of special cases of disturbance of T. a gullet it is also characterized by the gradual or suddenly coming difficulty of passability on a gullet, hypotonia. The X-ray pattern is defined by existence of narrowing of esophageal and gastric transition, lowering of a tone of a gullet, expansion of a gleam, availability in it of liquid, slime, the eaten food. The gullet is extended, bent (see fig. 1).
At X-ray inspection without reception of a contrast agent the expansion of a median shadow simulating a mediastinum disease is defined. The accepted contrast agent in flakes falls through gullet contents. The gas bubble of a stomach is not differentiated. Clearly the transfer heartbeat is defined. In early phases of a course of a disease disturbance of a tone of a gullet has intermittent character: after a delay of a contrast agent there comes disclosure of esophageal and gastric transition and movement as a failure of a contrast agent. Reception of spasmolysants during this period promotes expansion of the narrowed site and free intake of contrast medium in a stomach.
Morphological substrate — damage of intramural nerve fibrils of a gullet as a result of which the reflex of disclosure of the cardia is broken.
It is distinguished at roentgenoscopy, a X-ray analysis with use of a contrast agent in combination with reception of pharmacological drugs, in various projections, in vertical and horizontal position of the patient, X-ray cinematography.

 
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