, Volume 30, Issue 6, pp 669–673 | Cite as

Esophageal Involvement in Multiple System Atrophy

  • Hiroshige Taniguchi
  • Hideaki Nakayama
  • Kazuhiro Hori
  • Masatoyo Nishizawa
  • Makoto Inoue
  • Takayoshi ShimohataEmail author
Original Article


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.


Multiple system atrophy Esophageal involvement Dysphagia Food stagnation Aspiration pneumonia Sudden death 



This study was supported in part by a Grant from the Japan Foundation for Neuroscience and Mental Health.

Compliance with Ethical Standards

Conflict of interest


Supplementary material

455_2015_9641_MOESM1_ESM.docx (13 kb)
Supplemental Table 1. Clinical and videofluorographic findings in the amyotrophic lateral sclerosis group. M, male; F, female; NPPV, non-invasive positive pressure ventilation; L, Lower esophagus. Supplementary material 1 (DOCX 13 kb)
455_2015_9641_MOESM2_ESM.docx (12 kb)
Supplemental Table 2. Dysphagia outcome and severity scale (DOSS). Supplementary material 2 (DOCX 11 kb)


  1. 1.
    Marshall MB. Benign esophageal disease in the elderly. Thorac Surg Clin. 2009;19:321–32.CrossRefPubMedGoogle Scholar
  2. 2.
    Aubert M, Ohanessian J, Perret J, Micoud MJ, Barrie J. Shy-Drager syndrome and megaesophagus (author’s transl). J Chir (Paris). 1980;117:195–7.Google Scholar
  3. 3.
    Richter JE. Oesophageal motility disorders. Lancet. 2001;358:823–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Benarroch EE, Schmeichel AM, Sandroni P, Low PA, Parisi JE. Involvement of vagal autonomic nuclei in multiple system atrophy and Lewy body disease. Neurology. 2006;66:378–83.CrossRefPubMedGoogle Scholar
  5. 5.
    Gilman S, Wenning GK, Low PA, Brooks DJ, Mathias CJ, Trojanowski JQ, et al. Second consensus statement on the diagnosis of multiple system atrophy. Neurology. 2008;71:670–6.PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Pouderoux P, Shi G, Tatum RP, Kahrilas PJ. Esophageal solid bolus transit: studies using concurrent videofluoroscopy and manometry. Am J Gastroenterol. 1999;94:1457–63.CrossRefPubMedGoogle Scholar
  7. 7.
    Leopold NA, Kagel MC. Pharyngo-esophageal dysphagia in Parkinson’s disease. Dysphagia. 1997;12:11–20.CrossRefPubMedGoogle Scholar
  8. 8.
    Bisch EM, Logemann JA, Rademaker AW, Kahrilas PJ, Lazarus CL. Pharyngeal effects of bolus volume, viscosity, and temperature in patients with dysphagia resulting from neurologic impairment and in normal subjects. J Speech Lang Hear Res. 1994;37:1041–59.CrossRefGoogle Scholar
  9. 9.
    Ott DJ, Hodge RG, Pikna LA, Chen MY, Gelfand DW. Modified barium swallow: clinical and radiographic correlation and relation to feeding recommendations. Dysphagia. 1996;11:187–90.CrossRefPubMedGoogle Scholar
  10. 10.
    Jou J, Radowsky J, Gangnon R, Sadowski E, Kays S, Hind J, Gaumnitz E, Taylor A, Robbins J. Esophageal clearance patterns in normal older adults as documented with videofluoroscopic esophagram. Gastroenterol Res Pract. 2009;2009:965062.PubMedCentralCrossRefPubMedGoogle Scholar
  11. 11.
    Tsuji S. [MSA update]. Rinsho Shinkeigaku (Japanese). 2005;45:821–3.Google Scholar
  12. 12.
    Wenning GK, Tison F, Seppi K, Sampaio C, Diem A, Yekhlef F, et al. Development and validation of the unified multiple system atrophy rating scale (UMSARS). Mov Disord. 2004;19:1391–402.CrossRefPubMedGoogle Scholar
  13. 13.
    Shimohata T, Ozawa T, Nakayama H, Tomita M, Shinoda H, Nishizawa M. Frequency of nocturnal sudden death in patients with multiple system atrophy. J Neurol. 2008;255:1483–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Grossi L, Ciccaglione AF, Marzio L. Transient lower oesophageal sphincter relaxations play an insignificant role in gastro-oesophageal reflux to the proximal oesophagus. Neurogastroenterol Motil. 2001;13:503–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Bartlett DW, Evans DF, Smith BG. Oral regurgitation after reflux provoking meals: a possible cause of dental erosion? J Oral Rehabil. 1997;24:102–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Dodds WJ, Dent J, Hogan WJ, Helm JF, Hauser R, Patel GK, Egide MS. Mechanisms of gastroesophageal reflux in patients with reflux esophagitis. N Engl J Med. 1982;307:1547–52.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Hiroshige Taniguchi
    • 1
  • Hideaki Nakayama
    • 2
  • Kazuhiro Hori
    • 3
  • Masatoyo Nishizawa
    • 4
  • Makoto Inoue
    • 5
  • Takayoshi Shimohata
    • 4
    Email author
  1. 1.Department of DentistrySchool of Medicine, Fujita Health UniversityToyoakeJapan
  2. 2.Department of Respiratory MedicineTokyo Medical UniversityTokyoJapan
  3. 3.Division of Comprehensive ProsthodonticsNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
  4. 4.Department of Neurology, Brain Research InstituteNiigata UniversityNiigataJapan
  5. 5.Division of Dysphagia RehabilitationNiigata University Graduate School of Medical and Dental SciencesNiigataJapan

Personalised recommendations