Cast-off of esophageal mucosa

Introduction The symptoms and signs of mucosal injury can be manifested as submucosal hematoma. The hematoma causes the surface layer and the lamina propria of the esophageal mucosa to be completely stripped. It is tube-shaped and ejects from the mouth like a band hanging from the mouth and connected with the pharynx. "Esophageal mucosal exfoliation" is also known as "surface exfoliative esophagitis" and "traumatic exfoliative esophagitis". Esophageal mucosal injury is one of the common esophageal traumas. Most of them are negligent due to not serious injuries. Clinically, it can heal itself and less infection. The mechanism may be that the blood vessel is broken between the mucosa and the lamina propria after the esophageal mucosal injury, and a hematoma occurs. The esophageal mucosa is tubular exfoliation due to the continuous increase and expansion of blood. At this time, due to the effect of gravity, the lower end of the esophageal tube under the force of the blood can be greatly stimulated, such as vomiting, can cause the mucosa to rupture, such as the patient's mucosal tube type with vomiting and peeling, which is then turned over and released from the mouth. The exfoliated tube consists of a squamous epithelium with no inflammation or necrosis.

Cause

The cause of esophageal mucosal exfoliation may be related to the promotion of food, forcible swallowing of dry and hard food, or eating too cold and overheating and excessive consumption of spicy and irritating food. The esophageal mucosal injury or submucosal hematoma is first caused, and then the esophageal mucosal epithelial exfoliation is a tubular tube, which is spouted with food, often suspended outside the mouth, and is not easily broken when pulled out. Chronic inflammation of the esophagus, loss of water and so on, is the main cause of the disease.

The esophageal cast is generally considered to be an unexplained hyperplasia of the esophageal epithelium. If the vomiting occurs for some reason or the mucous membrane is gradually separated after the mild mucosal injury, the tube type is detached. Esophageal casts can occur in normal healthy individuals with neither infection nor chemical burns. Caused by mild esophageal mucosal damage, hot drinks, foreign body, frequent vomiting and other causes. Zhang Taichang et al reported two cases of esophageal casts with frequent vomiting as a cause. In recent years, some scholars have proposed that the esophageal tube type and the lower part of the esophagus have a high pressure area. Due to the pressure of this stage, part of the gas in the esophageal lumen is squeezed into the submucosa which is partially damaged and separated. When accompanied by severe vomiting, under the influence of relevant airflow mechanics factors, the surface of the mucosal exfoliation surface spreads evenly and rapidly to the full length of the esophagus, forming a complete esophageal tube type, and spit out with vomiting.

an examination

Related inspection

Esophagectomy fungal examination

Diagnosing the diagnosis of esophageal mucosal damage based on medical history and clinical symptoms. For esophageal mucosal exfoliation, a white tubular membrane is seen in the oral examination and connected to the pharynx. The X-ray swallowing examination can be seen as a "dual-chamber esophagus" to establish a diagnosis.

In a typical case, within a few weeks before the discharge of the cast, the patient feels a slight discomfort under the xiphoid or upper abdomen. There is mild difficulty in swallowing or belching. There is no aura, and the throat is burning only after entering the hot drink or hot wine. Feeling, after a few retching, spit out a little blood, then spit out the tubular mucosa.

After eating, I feel discomfort in the back of the chest, burning sensation and chest tightness, accompanied by frequent vomiting, a small amount of blood, foreign body sensation in the pharynx, and then spit out a white cord-like cast, sometimes need to be cut.

Differential diagnosis

1. Esophageal pemphigus: characteristic endoscopic findings are the formation of blisters, because it is easy to rupture, not often seen, more reports of edema, redness, erosion, ulcers and other non-specific inflammatory findings. The identification of reflux esophagitis is very difficult. The lesion involves the middle and upper esophagus, all the vascular permeability is low, the line and map-like, round and other various erosive ulcers can be used as identification points. The biopsy confirms that the spine cells in the epidermis are loosened and the spines are loosened.

2. Bullous epidermolysis: Epidermolysis bullosa is characterized by the occurrence of bullae on the skin after friction or trauma, complex genetic conditions, recessive dystrophy The vesicles of bullous epidermolysis are characterized by loose blisters, which are easily ruptured, mostly serous, and may also be accompanied by hemorrhagic bullae. Any part of the skin can occur, the mucous membrane is often involved, and large blisters occur. Erosion can also occur in the mucosa of the esophagus.

3. Pemphigus dermatitis: Pemphigoid dermatitis is inflammation, blisters and skin on the mucous membranes and skin of the conjunctiva, mouth, nose, throat, tracheal esophagus, female genital, urethra, vagina and anus. The blisters are damaged and the scar remains on the mucosa. If blistering and blistering of the oral and esophageal mucosa often lead to scar formation, very few people may have esophageal stenosis.

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