Iron deficiency dysphagia

Introduction to iron deficiency dysphagia Iron deficiency dysphagia is a thin diaphragm in the esophageal lumen, which is divided into upper esophageal fistula, middle esophageal fistula, and lower esophageal fistula according to its location in the esophagus. Most patients with esophageal spasm are asymptomatic. In the case of a healthy physical examination or accidental gastrointestinal angiography, a small number can be expressed as difficulty in swallowing, and both men and women can develop the disease. There are few pathological findings. Most patients with esophageal fistula have little change in histology of esophageal mucosa, and the size of hernia progresses slowly. It is in a relatively static state. A few autopsy shows mucosal atrophy of esophagus and pharynx, squamous epithelial cells. Larger and vacuolization, the upper esophageal muscle atrophy was replaced by collagen tissue. The glycogen of the esophageal epithelium was depleted when iron was deficient. The biopsy histology of the sputum was normal, and a few had chronic inflammation. basic knowledge The proportion of patients: 0.006% - 0.009% (more common in patients with iron deficiency anemia) Susceptible people: no specific population Mode of infection: non-infectious Complications: esophageal cancer

Iron deficiency dysphagia

(1) Causes of the disease

The cause of this disease is still unclear. Most people believe that iron deficiency is the most basic factor in this disease. This is because the lack of iron causes changes in the epithelial layer, leading to difficulty in swallowing. For example, patients with iron deficiency anemia often There is an upper esophageal fistula, and the clinical treatment uses iron without the need to dilate the esophagus to make the difficulty of swallowing disappear. This is a strong support for this theory.

Further research by Chisholm et al. found in 186 cases of iron deficiency:

1. Esophageal fistula accounted for about 10%, while the control group did not.

2. In patients with esophageal fistula due to iron deficiency caused by angular cheilitis, glossitis is more common than patients without esophageal fistula.

3. In patients with esophageal fistula, there are more cases of tooth loss and hypothyroidism than those without esophageal fistula. The above phenomenon indicates that iron deficiency is a prerequisite for upper esophageal fistula.

The reason for the high incidence of women may be due to the difficulty of dysphagia to reduce the intake of iron-containing diet, coupled with the loss of women's menstrual period iron, the baby occasionally the disease, it may be congenital reasons, may also be related to iron deficiency Related to anemia.

In the epidemiological investigation, some phenomena are difficult to explain with the above viewpoints. For example, it is found that normal people and those without anemia have esophageal fistula, or have difficulty swallowing but not anemia. This indicates that the relationship between iron deficiency and dysphagia is not completely consistent.

(two) pathogenesis

There are few pathological findings. Most patients with esophageal fistula have little change in histology of esophageal mucosa, and the size of hernia progresses slowly. It is in a relatively static state. A few autopsy shows mucosal atrophy of esophagus and pharynx, squamous epithelial cells. Larger and vacuolization, the upper esophageal muscle atrophy was replaced by collagen tissue. The glycogen of the esophageal epithelium was depleted when iron was deficient. The biopsy histology of the sputum was normal, and a few had chronic inflammation.

Iron deficiency dysphagia prevention

Iron deficiency is the basic factor of this disease. Due to the lack of iron, the lack of iron-containing enzyme system affects mucosal metabolism, causing changes in the epithelial layer, forming esophageal fistula, leading to difficulty in swallowing. In the early stage of no esophageal dilation, most cases are only used. Iron treatment can make dysphagia disappear, so early treatment of iron supplementation can make dysphagia difficult to improve.

Iron deficiency dysphagia complications Complications Esophageal cancer

Easy to pharynx and upper esophageal cancer.

Iron deficiency dysphagia symptoms common symptoms weight loss swallowing difficulty tongue nipple disappeared pale pale mouth palpebral esophageal symmetry expansion

The main symptoms are intermittent dysphagia, most of which occur when eating hard food. Eating liquid food is generally asymptomatic, and the patient feels that food is stuck in the upper chest.

Patients with Plummer-Vinson syndrome often have: weight loss, paleness, redness, red and smooth tongue, tongue nipple disappearing, most edentulous or completely edentulous, cleft palate, spoon-shaped nails, splenomegaly and even spleen, if The patient complained of dysphagia and the diagnosis was positive.

Iron deficiency dysphagia check

Hemoglobin, red blood cells, MCH, MCV, MCHC are all reduced, serum iron is decreased, iron is increased, and iron-deficient small cell anemia is present. In some cases, serum vitamins B12 and B6 are decreased, gastric acid deficiency, and severe cases may occur. anemia.

1. X-ray examination, if suspected of paralysis, depends on fluorescent film examination, often found in the anterior wall of the upper esophagus as eccentricity, the width is less than 2mm, can be seen in continuous filming, rare more than one sputum, such patients have May be complicated by oral cancer.

2. Endoscopy The image is a smooth, colored diaphragm-shaped hole with an eccentric opening below the level of the pharyngeal muscle. The film is sputum, sometimes thin enough to be detected by the examiner, and the rare sputum is very thick. Hard, hinder the passage of food, and if necessary, perform a cell brush or biopsy to exclude inflammatory stenosis and cancer.

About 40% of patients with Plummer-Vinson syndrome have atrophic gastritis, 30% of anemia, and 50% of mucinous edema. In some patients, antibodies to the thyroid and stomach wall cells can be detected.

Esophageal fistula is also present in some skin patients, such as bullous epidermolysis, Sjogren syndrome.

Diagnosis and diagnosis of iron deficiency dysphagia

Patients with dysphagia can be diagnosed by combining X-ray examination and endoscopy.

Combined with endoscopy and biopsy, it can be differentiated from esophageal cancer, esophageal stenosis, and esophageal muscle contraction.

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