Esophageal tuberculosis

Introduction to esophagus tuberculosis Esophageal tuberculosis (esophageal tuberculosis) is extremely rare in the clinic. In 1837, Denonvilliers of France first reported a case of esophageal tuberculosis confirmed by autopsy. Later, Torek (1931) reported the first case of primary esophageal tuberculosis (primary tuberculosis of theesophagus), followed by cases of esophageal tuberculosis. Esophageal tuberculosis is divided into primary and secondary types. Primary esophageal tuberculosis refers to Mycobacterium tubemulosis, which directly invades the esophageal mucosa. Tuberculosis is mainly esophageal tuberculosis. There are no obvious tuberculosis lesions in other parts of the body, but some The authors believe that there is no primary esophageal tuberculosis; secondary esophageal tuberculosis is often caused by direct or indirect invasion of the esophageal wall around the esophagus and mediastinal lymph nodes. basic knowledge The proportion of illness: 0.021% Susceptible people: no special people Mode of infection: non-infectious Complications: esophageal cancer

Esophageal tuberculosis

(1) Causes of the disease

Many clinical data indicate that there is very little esophageal tuberculosis in patients with sputum-positive cavities. Even if a large number of tuberculosis is swallowed into the digestive tract via the esophagus, direct inoculation of the esophagus is rare. The reason may be related to the esophageal mucosa for Mycobacterium tuberculosis. It has a strong ability to resist, and the esophagus is in a vertical direction. The tuberculosis bacteria pass quickly, and there is food. The saliva is continuously washed away, and it is not easy to stay in the esophagus. In addition, the mucosa of the esophagus is composed of vertical stratified squamous epithelial cells. It is conducive to the defense against tuberculosis.

Tuberculosis is the result of the interaction between the human body and Mycobacterium tuberculosis. Tuberculosis occurs only when there are many bacteria invading the human body, the virulence of bacteria and the low immunity of the body cause local resistance. Esophageal tuberculosis is mostly based on the patient's original disease. Caused by infection with Mycobacterium tuberculosis, susceptible factors include:

1. The body's resistance is reduced: such as tuberculosis, diabetes, malignant tumors, etc., surrogate therapy and in the late stage of the disease.

2. Low immune function: such as organ transplantation, long-term use of immunosuppressants, AIDS, etc.

3. The original esophageal diseases: such as reflux esophagitis, esophageal ulcer, esophageal stricture.

(two) pathogenesis

Esophageal tuberculosis occurs in almost all patients with advanced tuberculosis, laryngeal tuberculosis, mediastinal or bone tuberculosis, and primary esophageal tuberculosis is extremely rare. The following pathways are involved in esophageal involvement:

1 Infection due to swallowing of sputum, especially when there is malnutrition, food is stagnant in esophageal stagnation esophagitis or fungal infection (candida esophagitis), when cancer is present.

2 Throat tuberculosis spreads downward into the esophagus.

3 esophageal adjacent lymph node tuberculosis, spinal tuberculosis directly spread.

4 from the blood-borne spread away from organ tuberculosis.

5 retrograde lymphatic spread, the lymph of normal esophagus is drained to the lymph nodes around the trachea and around the bronchi. When these lymph nodes develop tuberculosis, tubercle bacilli can flow back to the esophagus through the lymphatic vessels.

The disease occurs in the esophagus, the upper segment, and more than the tracheal bifurcation level, the lesion range is more than 2 ~ 13cm away from the incisors, only 12% occur in the lower segment, which may be dense and the same with the tracheal bifurcation The esophagus is closely related.

Pathological typing

The pathological types of esophageal tuberculosis can be divided into three types:

(1) ulcer type: the most common, single or multiple, different sizes, esophageal tuberculosis in the early stage of tuberculosis infection and tuberculous granuloma (tuberculous granuloma), the formation of tuberculosis nodules (tubercle), As the disease progresses, caseous necrosis occurs in the nodules, ulceration, ulceration, usually the superficial ulcer, pale gray purulent base, rough edges, irregular, only involving the mucosa And submucosa, more severe ulcers rarely occur, once it occurs, often penetrate the muscle layer, break through the esophageal adventitia to form esophageal perforation, causing esophageal mediastinum or esophageal pleural sputum, such as invasion of the trachea, can form esophageal tracheal fistula If the aortic arch is involved, the patient may die due to major bleeding. The esophageal tuberculous ulcer often has a tendency to heal itself. During the healing process, due to fibrous tissue hyperplasia and scar formation, local esophageal stenosis and wall elasticity are reduced, and even The scar is pulled to form a traction diverticulum in the middle esophagus.

(2) Proliferative type: It can be divided into two types: stenosis type and granulomatous type. The lesions involve the esophageal wall and make it agglomerate thickening, mainly based on a large number of tuberculous granulation tissue and fibrous tissue hyperplasia. Unequal nodules, located in the deep mucosa and muscle layer, the mucosa is intact, and the proliferating tissue can sometimes protrude into the esophageal lumen with pseudotumor masses, resulting in narrowing of the lumen.

(3) granule type: this type is the least common, often occurs in severe and systemic systemic diseases, manifested as many grayish white nodules in the esophageal mucosa and submucosa, that is, a large number of numerous miliary granulomas, sometimes Ulcers can also form.

2. Pathological process

The pathological process of esophageal tuberculosis is roughly divided into four steps:

(1) When the mediastinum and the esophageal lymph node tuberculosis enlarge the esophagus, the patient begins to have symptoms such as dysphagia, swallowing pain and chest pain after the sternum. Esophageal X-ray examination shows external pressure changes in the esophagus, and local esophagus can be seen. A lump shadow.

(2) Infiltrating lymph nodes around the enlarged esophagus, adhesion to the esophagus and surrounding tissues or embedding in the esophageal wall. Esophageal X-ray examination may reveal signs of benign lesions in the esophagus.

(3) Caseous necrosis, liquefaction and ulceration of swollen lymph nodes can form abscesses in the esophageal wall; can also penetrate the muscular layer and mucosa of the esophagus to form a fistula and drain into the esophageal lumen; It can invade the esophagus and trachea at the same time, and there is an esophageal fistula.

(4) Esophageal muscle layer or submucosal tuberculosis liquefaction of necrotic tissue invaded the esophageal mucosa, gradually causing esophageal fistula, exudation, ulceration, proliferation and scar formation, esophageal X-ray examination showed irregular filling of the esophageal lumen, stenosis, tube X-ray signs such as stiff wall and poor expansion are similar to the X-ray findings of medullary esophageal cancer.

Esophageal tuberculosis prevention

Improving the body's immunity and avoiding contact with tuberculosis patients is an important measure to prevent esophageal tuberculosis. For patients with open tuberculosis, avoiding the secretion of respiratory secretions containing tubercle bacilli can significantly reduce the occurrence of esophageal tuberculosis.

Esophageal tuberculosis complications Complications Esophageal cancer

With the progress of the disease, esophageal tuberculosis can be complicated by traction diverticulum and even perforation of the diverticulum, esophageal obstruction, recurrent laryngeal nerve paralysis, esophageal mediastinal fistula, esophageal pleural fistula and esophageal fistula and other complications, and corresponding symptoms and signs, and finally, the patient Can cause long-term fever, consumption, poisoning and systemic dysfunction, and the occurrence of dyscrasia, combined with various conditions of pathogenic bacteria infection, leading to death.

Esophageal tuberculosis symptoms Common symptoms Tired sternal pain Lymph node tuberculosis Tuberculosis Poisoning Back pain Weak weight loss Swallowing pain Swallowing difficulty night sweats

The clinical manifestations of esophageal tuberculosis vary in severity. Patients often have difficulty swallowing, swallowing pain or post-sternal pain, and lack of typical symptoms of tuberculosis. Some patients have hematemesis as the first symptom, and even the medical treatment cannot be controlled. The bleeding of the digestive tract.

In general, esophageal tuberculosis patients with mild disease can be asymptomatic, only found after post-mortem autopsy; severe cases have fever, fatigue, weakness, weight loss and night sweats and other systemic symptoms, the vast majority of esophageal tuberculosis symptoms belong to the disease course A local manifestation of a significant decline in late-stage systemic resistance, patients often die without diagnosis, because esophageal tuberculosis can be complicated by advanced tuberculosis, or with throat tuberculosis, the symptoms of the esophagus are often masked by the symptoms of the lungs or throat.

The clinical manifestations of esophageal tuberculosis have the following three characteristics:

1. The onset symptoms are not specific

Esophageal tuberculosis has a slow onset, almost all have dysphagia and mild symptoms of swallow dysfunction. Some patients are also accompanied by post-sternal pain, discomfort, fatigue and night sweats. These symptoms and development process are similar to esophageal malignancies, and occasionally The attending doctor regarded the main symptoms of esophageal cancer, and thus misdiagnosed and mistreated without relevant comprehensive examination.

2. Low incidence

Because esophageal tuberculosis is rare in clinical practice, it is easily overlooked in diagnosis and differential diagnosis. Sometimes patients often see a doctor because of dysphagia. It has been found that tuberculosis involving tuberculosis is not considered in combination with tuberculosis in other areas. may.

3. Different clinical manifestations

The pathological type of esophageal tuberculosis and the degree of damage to the esophageal mucosa are different, and the clinical manifestations of patients are also different.

(1) Ulcer type: The prominent symptoms are pain in the throat or sternum, sometimes back pain, mostly persistent, aggravated when swallowed, the patient has a fear of eating, and then lose weight.

(2) Proliferative type: manifested as progressive dysphagia.

(3) Granular type: The symptoms of granules are mild, and sometimes severe cases may cause difficulty in swallowing.

Esophageal tuberculosis examination

As with other diseases, the diagnosis of esophageal tuberculosis must be comprehensive. The clinical manifestations, imaging examination and esophageal endoscopy are lack of pathogenic evidence, which may lead to missed diagnosis and misdiagnosis. Laboratory tests, especially bacteriological examination, are esophageal tuberculosis. The core of the diagnosis is to confirm the diagnosis of the examination items. At present, the laboratory examination methods commonly used in clinical practice are as follows.

Bacteriological examination

The biopsy specimens obtained by esophagoscopy are cultured. If tubercle bacilli can be found, the esophageal tuberculosis can be diagnosed, but almost all patients with dysphagia are treated in the thoracic surgery or gastroenterology department of the general hospital, instead of the tuberculosis specialist hospital. Factors such as the content of Mycobacterium tuberculosis in biopsy specimens and stricter culture conditions make the positive rate of bacterial culture very low, and it is very difficult to implement in more comprehensive hospitals in China.

2. Histopathological examination

Rosario et al. (1989) reported that acid-fast bacilli were obtained by biopsy specimens obtained from esophagoscopy, but they were unable to find tubercle bacilli by bacterial culture. They speculated that it may have been due to anti-tuberculosis treatment. .

3. Tuberculin test

Tuberculin is a specific product of Mycobacterium tuberculosis. It is a biological preparation for identifying whether the human body is infected with Mycobacterium tuberculosis and the human body's response to Mycobacterium tuberculosis infection. It is widely used in epidemiological investigation, clinical diagnosis and differential diagnosis of tuberculosis. The tuberculin test is a purified protein derivation of tuberculin test, the PPD test.

In patients with suspected esophageal tuberculosis, if the result is strongly positive, it is conducive to the diagnosis of esophageal tuberculosis; if it is a general positive reaction or negative, it is necessary to increase the concentration of repeated tests, and if the results still have no significant changes, then The diagnosis of esophageal tuberculosis may be excluded, but it should be noted that some patients with severe disease, patients treated with immunosuppressive agents and patients with miliary esophageal tuberculosis may have a negative reaction; for patients with newly converted PPD, the possibility of esophageal tuberculosis should be considered.

4. Serological test

Serological examination of serum lectin test titer greater than 1:160, has a certain diagnostic value, detection of human mannan antigen by radioimmunoassay and enzyme-linked method, or detection of fungal antibodies by agarose diffusion and reverse immunoelectrophoresis, It seems to have special value for fungal infections, but needs further verification.

5. Other inspections

(1) ESR: Due to tissue necrosis and inflammatory changes, the erythrocyte sedimentation rate of patients with severe and acute advanced esophageal tuberculosis increases rapidly. When the tissue is repaired, the erythrocyte sedimentation rate can return to normal when the lesion is absorbed.

(2) Blood: esophageal tuberculosis patients with secondary anemia due to long-term chronic consumption and nutritional disorders, red blood cells and hemoglobin can be reduced to varying degrees, but chronic hypoxia and respiratory insufficiency often have compensatory erythrocytosis.

Film degree exam

Imaging examination is an important method for diagnosing esophageal tuberculosis. Esophageal sputum angiography is the first choice for imaging examination of esophageal tuberculosis. It can accurately determine the length of the lesion, mucosal and luminal changes, chest X-ray, and plain film. And cervical and thoracic vertebrae, lateral radiographs may be found in the lung tuberculosis lesions, cervical and thoracic tuberculosis caused by vertebral destruction and cold abscess formation, mediastinal and hilar lymphadenopathy and calcification, mediastinal effusion and abscess caused by mediastinal shadow Widening and other signs, CT examination as an auxiliary means, for the thickness of the esophageal wall, with or without fine calcification, small necrotic cavity, around the esophagus such as a small amount of fluid in the mediastinum, abscess, spinal tuberculosis damage, etc., more accurate, MRI examination has limited diagnostic value for esophageal tuberculosis.

(1) esophageal barium angiography:

If esophageal tuberculosis patients have X-ray barium angiography due to difficulty in swallowing, their X-ray findings are lack of specificity. If the diagnosis is limited to multiple diseases, common diseases are easily misdiagnosed as esophageal malignant tumors, sometimes esophageal tuberculosis. X-ray performance may even be normal, often resulting in missed diagnosis.

The sputum angiography of esophageal tuberculosis can detect the following signs: 1 The ulcer type occurs almost in the middle part of the esophagus, mainly in the esophageal sac ulcer, which can be seen in the shadow, but not all patients can see the shadow formed by the ulcer. A sign, due to scar contraction and adhesion of surrounding tissue, the lumen is slightly narrow or normal, the mucosal texture is rough and irregular, the contour of the wall can be irregularly jagged, but the wall stiffness is not obvious, there is still a certain degree of expansion, The sputum can pass smoothly. The 2 proliferative type is more common in the middle part of the esophagus, followed by the lower part. The X-ray examination shows the stenosis of varying degrees. It is a limited filling defect of the side wall. The size is different and the wall has certain elasticity. The agent passes slowly, without obstruction, and has a soft tissue mass near the filling defect. It is a thickened wall or enlarged lymph node. The mucosal texture of the lesion area can be normal, or deformed or even completely disappeared, and a soft tissue mass is formed. Bilateral shadow, the outer edge is formed by the adhesion of the expectorant to the mucosa, the medial edge is formed by the thickening of the wall, and the mediastinal lymph node is 3 The invasion and esophageal changes are like proliferative tuberculosis. Sometimes, when tuberculosis only invades the muscular layer and the esophageal lining, the wall of the bulge that protrudes into the cavity sometimes forms an oval filling defect that is indistinguishable from the tumor, and often misdiagnosis occurs. Observation can be found that there may be enlarged lymph nodes around the lesion, adjacent to the esophagus may be compressed, displaced or pulled into an angle, 4 with esophageal diverticulum or perforation can show the formation of esophageal diverticulum and esophageal fistula, the change is like ulcerative tuberculosis, 5 sputum tuberculosis is extremely rare, mostly due to local necrosis of tuberculosis around the cardia caused by cheese necrosis. It is easily misdiagnosed due to lack of characteristic performance. The main X-ray sputum angiography sign is that the sputum is slightly worse when it passes through the cardia. The mucosa of the cardia is thickened, there is a filling defect under the mucosa, there is a nodular mass in the fundus, and the mucosa is shunted. Although the lumen is narrow or filled with defects, the shape is still regular, and the cardia can still be expanded, such as a patient. The above signs, combined with the history of tuberculosis, should consider the possibility of the disease.

(2) CT examination:

Esophageal CT scan is not easy to diagnose esophageal tuberculosis, but esophageal CT scan in the case of negative esophageal X-ray examination can clearly show the swelling of the trachea, trachea, parabronchial and paraesophageal lymph nodes, for esophagus The diagnosis of tuberculosis is of great significance. When performing CT scan, it is best to dilute the iodine contrast agent orally. The scan range is from the neck to the diaphragm. CT scan can show the following signs: 1 irregular lumen of the esophagus, wall enlargement Thick and small ulcers, when there is caseous necrosis in the wall of the tube, it can show small necrotic cavity. 3 If esophageal tuberculosis is caused by direct invasion of the esophageal wall around the esophagus and mediastinal lymph nodes, it can be seen close to the esophageal wall. Adjacent swollen lymph nodes, 4 if there is perforation of the esophagus, it can show effusion in the mediastinum, abscess formation and fistula between the esophagus and trachea, and visible free gas in the mediastinum, effusion around the esophagus and soft tissue swelling.

(3) MRI examination: MRI examination has little significance for the diagnosis of esophageal tuberculosis, but it can be multi-axial imaging, so it shows better to the mediastinum and spine. For spinal destruction, mediastinal lymphadenopathy, mediastinal inflammation caused by esophageal mediastinum And the display of the mediastinal abscess is helpful.

2. Endoscopy

Endoscopic examination can directly observe local damage, and can perform biopsy and bacteriological examination, often with positive findings. Repeated endoscopic biopsy can improve the positive rate of diagnosis, but there are 5 consecutive endoscopy. The biopsy was still a negative result, and the final operation was to confirm the diagnosis of esophageal tuberculosis. Therefore, Eng et al. (1991) suggested that if the esophageal endoscopic repeat biopsy continues to be negative, the experimental anti-tuberculosis treatment can be closely observed, such as difficulty in swallowing during the treatment. Symptoms of chest pain and tuberculosis poisoning are alleviated. If the endoscopic findings are narrowed or even healed, and there is no evidence of tumor, it can be diagnosed as esophageal tuberculosis. The test treatment time should not exceed 2 months. If there is no sign of improvement within 2 months, The possibility of esophageal malignancy should be considered.

If the esophageal ulcer is found to be deeper or the local wall is separated by multiple ulcers under endoscopic direct vision, special attention should be paid to the possibility of esophageal tuberculosis. In fact, all kinds of general manifestations under endoscopic direct vision are for esophageal tuberculosis or The diagnosis of malignant tumors is not qualitative, so many authors in the past believe that endoscopy is not helpful in the diagnosis of esophageal tuberculosis. The clinical significance of esophagoscopy is not that it can diagnose tuberculosis, but that it can be used for esophageal tuberculosis. Esophageal cancer or other lesions are excluded from diagnosis.

Endoscopy examinations are more characteristic of the microscope:

1 The esophageal mucosa is shallow in rat rat ulcer, the base is grayish white, with exudate and local edema.

2 The esophageal mucosa may have a plurality of yellow bulging granulation tissue, the so-called tuberculosis ball, which is soft and brittle, but is not easy to bleed.

3 Proliferative mucosa was seen, and there were more tiny yellow sputum covering on the mucosa.

4 When there is an esophageal tracheal fistula, you can see the mouthwash. When coughing, there may be gas or secretions spilling out of the mouth.

5 Granuloma can be seen by biopsy, and acid-fast bacillus can be found by acid-fast staining.

6 If the tuberculosis around the esophagus is caused by tuberculosis, endoscopic tube compression can be seen in the esophageal wall, and the lumen is narrow; if the tuberculosis around the esophagus has broken into the esophagus, it can be seen in casein and necrotic granulation tissue.

7 If the lesion has healed during the examination, different degrees of scarring and stenosis can be seen.

Diagnosis of esophageal tuberculosis

diagnosis

Esophageal tuberculosis combined with medical history, clinical manifestations, X-ray and endoscopy may make a diagnosis, mainly relying on the latter two examinations, especially patients with tuberculosis, spinal tuberculosis, throat tuberculosis or mediastinal lymph node tuberculosis, dysphagia or Pain in the back of the chest when eating, it is suspected that this disease may be.

The following points can be used as a reference for clinical diagnosis: 1 low age, high incidence under 50 years old; 2 female patients; 3 short course, patients with dysphagia and chest pain are generally less than 3 months; 4 history of tuberculosis About 50%.

According to the above points, for patients with suspected esophageal tuberculosis, focus on the history of tuberculosis and the history of tuberculosis exposure, conduct tuberculin test, comprehensively analyze the results of other auxiliary examinations, repeat endoscopy if necessary, clear histological diagnosis, chest CT examination You can understand the lungs and mediastinal lymph nodes, comprehensive analysis of CT values, to understand the extent of lesions, can reduce the blindness of diagnosis and treatment, and reduce the rate of surgical exploration.

Differential diagnosis

Esophageal tuberculosis should be identified with the following diseases:

Esophageal cancer

Ulcer-type esophageal tuberculosis is easily misdiagnosed as esophageal cancer. The symptoms caused by esophageal lesions are often concealed by other organ tuberculosis symptoms, until the lesion causes esophageal stenosis, and when there is progressive dysphagia, it is easy to be confused with esophageal cancer, especially 40 years old. The above patients have ulcerative esophageal tuberculosis, and esophageal X-ray barium meal examination alone may sometimes have certain difficulties in the differential diagnosis of esophageal cancer. In such cases, endoscopic biopsy can confirm the diagnosis.

Patients with esophageal cancer generally have no history of active tuberculosis. The age of onset of patients is more than 50 years old. There is often no fever, and dysphagia or post-sternal pain is the main manifestation. The course of disease progresses rapidly, and the weight is significantly reduced in the short term. X-ray examination It can be seen that the lumen is narrow, the wall is stiff, there is obvious filling defect, the surrounding mucosa is obviously damaged, and there may be shadows, esophageal exfoliative cytology and endoscopy can confirm the diagnosis. The X-ray manifestations of esophageal tuberculosis are large ulcers and less filling defects. The wall stenosis is not severe, and the boundary between the lesion and the normal wall is not obvious. If the patient has throat or tuberculosis at the same time, there is a symptom of tuberculosis, which is helpful for the diagnosis of esophageal tuberculosis.

In summary, the differential diagnosis of esophageal tuberculosis and esophageal cancer is as follows:

(1) Esophageal tuberculosis occurs mostly in young and middle-aged, younger age, less than 45 years old, more common in women; and the incidence of malignant tumors is more than 50 years old, more common in men.

(2) Esophageal tuberculosis patients have a history of tuberculosis or history of tuberculosis exposure. Chest X-ray examination indicates that there are old tuberculosis or active tuberculosis in the lungs.

(3) The clinical symptoms of esophageal tuberculosis are mild, the dysphagia caused by tuberculous esophageal stricture progresses slowly, and it is non-progressive dysphagia. It is not related to food traits, the course of disease is often short, anti-spasmodic treatment is effective; esophageal malignant tumor Dysphagia and chest pain are progressively aggravated, often in a short period of time (3 months to half a year), severe dysphagia, and generally worse, the course of disease is longer, often accompanied by weight loss symptoms.

(4) Esophageal tuberculosis skin tuberculin test (PPD skin test) positive, serum tuberculosis antibody positive.

(5) X-ray barium angiography: esophageal tuberculosis has filling defects and ulcers in the esophageal cavity, or the mucosa is altered by worm-like changes, the wall of the tube is slightly stiff, and the mediastinal lymph node tuberculosis compresses the esophagus to cause filling defects, mostly curved, local The mucosa is flat, and there is soft tissue swelling or calcification of tuberculosis around the lesion. The esophageal cancer wall is irregular, stiff, and the mucosa is obviously damaged. The filling defect is obvious and irregular.

(6) esophagoscopy: esophageal tuberculosis can be seen mucosal inflammation, ulcers, nodules, thickening, scar or stenosis, biopsy can be clearly diagnosed, mediastinal lymph nodes, tuberculosis, esophagus, esophageal endoscopy visible external pressure Sexual changes, mucosal smoothing, invasion of the esophageal wall can be seen similar to esophageal tuberculosis changes, requiring biopsy to confirm the diagnosis.

2. Esophageal leiomyoma

Accidental lesions are occasionally misdiagnosed as esophageal leiomyomas, esophageal leiomyomas in patients with esophageal sputum angiography can be seen with smooth margin filling defects, upper and lower borders and normal esophageal clear boundary and other typical X-ray signs, combined with medical history, diagnosis More difficult, the wall narrowing of esophageal tuberculosis is transitional, endoscopy also helps differential diagnosis.

3. Esophageal other external pressure lesions

Esophageal barium angiography alone is difficult to identify the cause of esophageal compression. Esophageal CT scans can generally determine whether the esophageal compression is caused by lymph nodes around the esophagus, mediastinal tumors or intrapulmonary tumors, such as suspected massive intravascular malformation. Dysphagia, digital subtraction angiography is important for diagnosis.

4. Esophageal peptic ulcer

Esophageal peptic ulcer occurs in the lower esophagus. Patients often have esophageal hiatus hernia and gastroesophageal reflux. Esophageal barium sputum examination shows that the shadow is mostly single, sometimes multiple, round or oval, around the shadow The esophagus may have different degrees of stenosis due to sputum or scar contraction. Esophageal tuberculosis occurs mostly in the esophagus. In the upper segment, there is no stenosis in the lesion lumen.

5. Reflux esophagitis

Reflux esophagitis has typical post-sternal pain and burning sensation. It occurs frequently after meals. Endoscopic examination shows that the lesion is confined to the lower esophagus, and gastroesophageal reflux can be found. Mucosal biopsy can be identified.

6. Esophageal varices

Esophageal varices should be differentiated from proliferative esophageal tuberculosis. The former has a history of cirrhosis and portal hypertension. Esophageal sputum angiography shows thick esophageal mucosal folds, irregular tortuosity, sputum-like, less stenosis, no ulceration Occurrence, CT intensive scan can be seen in the esophageal mucosa tortuous veins, if necessary, esophagoscopy.

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