Esophageal cicatricial stricture

Introduction to esophageal scarring The most common cause of esophageal scar stenosis is the swallowing of strong alkali or strong acid causing chemical burns of the esophagus. The scar tissue shrinks after healing and the esophageal lumen is narrow. After swallowing caustic chemicals such as acid and alkali, the mouth, throat, and sternum sometimes showed burning pain and drooling, nausea, vomiting, low fever, irritability, and the patient refused to eat. In addition, gastroesophageal reflux esophagitis forms ulcers and scar contractions. Scarring can also occur after esophageal trauma and surgery. basic knowledge The proportion of illness: 0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: perforation of the esophagus acute mediastinal inflammation esophageal injury

Causes of esophageal scarring

Chemical factors (45%):

Most cases of esophageal chemical burns in children are caused by accidental use of household acidic or alkaline chemicals, and adults are mostly caused by suicide attempts.

Disease factors (35%):

In the case of repeated recurrence of esophageal malignant tumors, esophageal scar stenosis can also be formed. In another case, on the basis of long-term inflammation and ulceration in the lower esophagus, esophageal stenosis can also be caused if gastroesophageal reflux occurs.

Etiology

Most cases of esophageal chemical burns in children are caused by accidental use of household acidic or alkaline chemicals, and adults are mostly caused by suicide attempts.

Pathological change

After swallowing caustic chemicals, the esophageal tissue is burned. The severity of the damage is related to the type, concentration, amount, and length of exposure of the swallowed chemical. Alkaline chemicals cause liquefaction necrosis of the tissue and can penetrate into the deep tissue of the esophageal wall. In severe cases, the whole layer of the esophageal wall may be ulcerated and perforated. Acidic chemicals cause tissue coagulative necrosis, and the degree of damage to esophageal tissue is generally lighter than that of alkaline chemicals, but high concentrations of acidic chemicals can also cause severe damage. The gastric mucosa is sensitive to acidic chemicals, and the gastric mucosal damage caused by fasting exposure to strong acid is often more serious than the esophagus. Caustic chemicals generally have a longer residence time in the natural stenosis of the esophagus, and the damage caused at these sites is also heavier.

The degree of tissue damage caused by chemical burns of the esophagus can be divided into three levels. Once burned lesions are limited to the esophageal mucosa causing congestion, edema and epithelial shedding, no scar tissue after healing, or only a small amount of scar tissue, the esophageal lumen may not be narrow. The degree of injury to the esophageal tissue was twice as deep as that of the mucosa and submucosa, forming an ulcer. The granulation tissue was grown 2 to 3 weeks after the burn, and the scar was formed after healing to cause esophageal stenosis. Third-degree burns involve lesions involving the entire esophageal wall and even the tissues around the esophagus, often leading to perforation of the esophagus and acute mediastinal inflammation. Esophageal scar stenosis caused by gastroesophageal reflux often occurs on the basis of long-term inflammation and ulceration in the lower esophagus. Postoperative esophageal scar stenosis occurs in the esophageal and gastrointestinal anastomosis sites, and granulation tissue grows during the healing process to form a circular scar stenosis.

Prevention of esophageal scar stenosis

In terms of prevention, there should be a few points:

1. Vigorously promote the harm of children's esophageal burns to society and family and children's physical and mental health; 2 Apply a fixed container to store strong acid and alkali chemical corrosive agents, and mark them conspicuously, and store them in places that are difficult for children to get. Environmental safety is a child accident prevention. Guarantee of damage.

2. Strengthen the health awareness of preventing accidental injuries among children, and use some educational films, brochures and other forms to promote the preventability and prevention of esophageal burns in kindergartens, schools and communities, especially in rural areas. .

3, parents, kindergartens, schools should strengthen the safety education for young children, using cartoons, games and other methods to cultivate children's ability to identify and reduce the phenomenon of misconduct.

4. Strengthen rural health care work and prevention, treatment and training of esophageal burns, so that children can receive timely and correct treatment, and those who are seriously transferred should be transferred to the hospital as soon as possible to reduce the damage.

5, far away from the hospital, can be rescued at home, such as taking acid, immediately take cooking oil, milk, egg white, liquid paraffin, to protect the digestive tract mucosa, accidentally take strong alkali, immediately take lemon juice, orange juice or rice vinegar and other neutralization Acidity and alkalinity, remember to ban gastric lavage after strong acid and alkali, induce vomiting, neutralize corrosive agents in time, the earlier the treatment time, the lighter the degree of esophageal infection and stenosis, the fewer times the esophagus is dilated, the better the effect.

Complications of esophageal scar stenosis Complications esophageal perforation acute mediastinal inflammation esophageal injury

The early provision of neutralizers and treatments can greatly reduce the incidence of complications. The complications of this disease are as follows:

1. When the tissue damage caused by chemical burning of the esophagus is serious, the patient may have esophageal perforation and acute mediastinal inflammation.

2, due to esophageal injury, can be complicated by esophageal infection.

3, the esophageal adhesion is severe in the scar segment, if the forced resection of bleeding, trauma, and easy to cause thoracic catheter, azygous vein and other secondary injuries, the risk of surgery is large, so the use of esophageal spasm to prevent more serious complications.

Symptoms of esophageal scar stenosis Common symptoms Irritability, nausea, difficulty breathing, dysphagia, low fever

After swallowing caustic chemicals such as acid and alkali, the mouth, throat, and sternum sometimes showed burning pain and drooling, nausea, vomiting, low fever, irritability, and the patient refused to eat. After a few days of burns, the mucosal edema gradually subsided and began to enter the fluid food. If the degree of burns is heavier and scar tissue is formed during the healing process, the edema will disappear several days after the burn, and the phlegm will disappear. The swallowing function will temporarily improve. After 2 to 3 weeks, the scar tissue shrinks, causing the esophageal stenosis and dysphagia. Symptoms, and thus signs of weight loss, dehydration, etc. Cases of severe perforation leading to perforation of the esophagus or gastric perforation present symptoms and signs of shock, hyperthermia, acute mediastinal inflammation, and abdominal infections early in the burn. If the chemical inhaled into the throat and causes laryngeal edema, it is clinically difficult to breathe. Esophageal scar stenosis caused by gastroesophageal reflux often has a history of long-term esophagitis, and there may be a small amount of hematemesis after ulceration of the esophageal mucosa. The esophageal stenosis is in the lower part of the esophagus, and the range is limited. Esophageal stenosis after surgery often presents with symptoms of dysphagia at 2 to 3 weeks after surgery.

Examination of esophageal scar stenosis

X-ray examination of esophageal barium meal can show the location, extent and extent of stenotic lesions. The esophageal stenosis caused by caustic chemical burns often presents a narrow esophageal lumen, a narrow stenosis, irregular edges, uneven thickness, and stiff esophageal wall. The sputum is in the stomach, or the esophageal cavity is highly obstructed, the expectorant can not pass, the stenosis caused by esophagitis is often located in the lower esophagus, the lesion range is limited, the disease course is long, the stenosis is severe, the upper esophagus May be enlarged, the esophageal stenosis after surgery, the esophageal lumen often has a limited annular stenosis.

Esophagoscopy can be seen in the narrow esophageal lumen, the esophageal wall is replaced by scar tissue, 12 to 48 hours after the esophageal chemical burn, early esophagoscopy can confirm the diagnosis of the burn and the extent of the lesion, but at this time the esophagus Due to acute inflammation and edema, the tissue is vulnerable to the perforation of the esophagus. Esophagoscopy is performed 2 to 3 weeks after the burn to help understand the stenosis of the esophageal lumen and the location and extent of the stenosis.

Esophageal and biopsy of esophageal cancer after surgery can help identify the stenosis caused by cancer recurrence.

Diagnosis and differentiation of esophageal scar stenosis

Can be diagnosed based on clinical symptoms and laboratory tests.

The cause of this disease is clear, under normal circumstances, no need for differential diagnosis, but in some cases of tumor recurrence can also be expressed as esophageal scar stenosis, so esophageal and biopsy of esophageal cancer after surgery can be helpful for identification.

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