Skip to main content
Log in

Esophageal Involvement in Multiple System Atrophy

  • Original Article
  • Published:
Dysphagia Aims and scope Submit manuscript


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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others


  1. Marshall MB. Benign esophageal disease in the elderly. Thorac Surg Clin. 2009;19:321–32.

    Article  PubMed  Google Scholar 

  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.

    CAS  Google Scholar 

  3. Richter JE. Oesophageal motility disorders. Lancet. 2001;358:823–8.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  7. Leopold NA, Kagel MC. Pharyngo-esophageal dysphagia in Parkinson’s disease. Dysphagia. 1997;12:11–20.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Tsuji S. [MSA update]. Rinsho Shinkeigaku (Japanese). 2005;45:821–3.

    Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

Download references


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

Author information

Authors and Affiliations


Corresponding author

Correspondence to Takayoshi Shimohata MD, PhD.

Ethics declarations

Conflict of interest


Electronic Supplementary Material

Below is the link to the electronic supplementary material.


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)

Supplemental Table 2. Dysphagia outcome and severity scale (DOSS). Supplementary material 2 (DOCX 11 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Taniguchi, H., Nakayama, H., Hori, K. et al. Esophageal Involvement in Multiple System Atrophy. Dysphagia 30, 669–673 (2015).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: