Dysphagia as a manifestation of esophageal tuberculosis: a report of two cases

Abstract

IntroductionEsophageal involvement by Mycobacterium tuberculosis is rare and the diagnosis is frequently made by means of an esophageal biopsy during the evaluation of dysphagia. There are few cases reported in the literature.Case presentationWe present two cases of esophageal tuberculosis in 85- and 65-year-old male Caucasian patients with initial complaints of dysphagia and epigastric pain. Upper gastrointestinal endoscopy resulted in the diagnosis of esophageal tuberculosis following the biopsy of lesions of irregular mucosa in one case and a sessile polyp in the other. Pulmonary tuberculosis was detected in one patient. In one patient esophageal stricture developed as a complication. Antituberculous therapy was curative in both patients.ConclusionAlthough rare, esophageal tuberculosis has to be kept in mind in the differential diagnosis of dysphagia. Pulmonary involvement has important implications for contact screening.

Tuberculosis presenting as dysphagia: Clinical, endoscopic, radiological and endosonographic features

“…A majority of patients with esophageal tuberculosis have linear ulcerative lesion with or without extrinsic bulge in the mid esophagus as was also in our study 2345678910. The mid esophagus is the most common site of involvement because of its proximity to the hilar and mediastinal lymph nodes surrounding the bifurcation of the trachea 2345678910. The endoscopic mucosal biopsy specimens can help in the diagnosis of esophageal tuberculosis, but one of the study has shown that the diagnostic yield of biopsies obtained after a single endoscopic session was 50% and obtaining biopsies from multiple endoscopic sessions increased the diagnostic yield 9.…”

“…In patients with tuberculosis, dysphagia can occur because of various mechanisms like compression by the surrounding tubercular peri-esophageal lymph nodes, associated mediastinal fibrosis, ulceration and/or polypoidal lesions in the esophagus, or altered motility 2345678910. In our study, a majority of the patients (50%) had dysphagia because of extrinsic compression by the mediastinal lymph nodes whereas 36% patients had dysphagia because of esophageal mucosal involvement.…”

A nutritional approach to esophageal tuberculosis - case report

“…10 The presence of dysphagia, as presented, may compromise nutritional status, leading to weight loss due to dietary inadequacy, since the individuals present food consistency restrictions, as an attempt to adapt to the symptom, thus reducing the intake necessary for the adequate nutrition, a factor that can directly interfere with the recovery process. 11 Various works emphasize that the dietary orientation should be individualized, precaution regarding the risk of aspiration and the adequate choice of access route for food help to prevent malnutrition in patients with dysphagia, where care of a multidisciplinary team are necessary for an effective recovery, so that the association of nutritional and speech therapy therapy will allow better results for the recovery process of the patient as a whole. 12,13 The symptoms commonly present in digestive tract disorders, as observed in the case, are related to food intake, such as: nausea, vomiting, diarrhea, early satiety, intestinal constipation, xerostomia, dysgeusia and dysphagia, and may contribute significantly to the nutritional status and, therefore, should be constantly monitored.…”

Blastomicosis oral, papilomatosis laríngea y tuberculosis esofágica

“…Presenta una prevalencia de alrededor del 0,15% de los casos de TB y 0,3% con relación a los casos específicos de TB gastrointestinal (1,2) . Generalmente se ve afectado el tercio medio esofágico a la altura de la carina (1,3) , y los síntomas se presentan según el tipo de compromiso: disfagia (en el 90% de casos) en la forma hipertrófica, y dolor retroesternal con odinofagia en la forma ulcerativa (2,4) . Se debe considerar el diagnóstico diferencial con carcinoma esofágico (1,3) .…”

“…Existen varios mecanismos de infección: inoculación por esputo deglutido; extensión directa a partir de una tuberculosis faríngea; diseminación hemática de un sitio distante, o diseminación linfática retrógrada desde las glándulas peritraqueales y peribronquiales (asiento frecuente de TB). La mayoría de los casos ocurre desde estructuras adyacentes como ganglios linfáticos mediastinales, focos pulmonares, o infección vertebral tuberculosa en la región cervical (1,2) .…”