Esophageal dysfunction on psychotropic medication. A case report and literature review.

We report the association of long-term clozapine and clomipramine therapy with severe esophageal dilation and hypomotility in a patient with chronic schizophrenia leading to life threatening aspiration pneumonia. Severe aspiration pneumonia manifested suddenly and required intubation and intensive care. Gross impairment of swallowing function with esophageal dilation and hypomotility was detected on videofluoroscopy and manometry. The patient recovered well following a reduction in the dose of clozapine and the withdrawal of clomipramine. The restoration of esophageal function was documented by manometry. The reported side effects and possible pharmacological actions of clozapine, an atypical neuroleptic, and clomipramine, a tricyclic antidepressant, on esophageal motility are discussed.