Esophageal tuberculosis: Uncommon of common

Abstract

Background and AimEsophageal involvement in tuberculosis (TB) is rare and is usually secondary. Data on esophageal TB are scarce. We aimed to analyze clinical and endoscopic features and outcomes of treatment in esophageal TB.MethodsWe retrospectively identified patients with esophageal TB from January 2014 to December 2016 at GB Pant Hospital. Well‐defined granuloma with or without caseation and/or acid‐fast bacilli on staining either from esophageal biopsy or the adjacent mediastinal lymph node fine‐needle aspiration cytology (FNAC) specimen, along with clinical features and response to antitubercular therapy (ATT), were collectively considered to diagnose definite TB. Treatment received and response to therapy were documented and analyzed.ResultsA total of 19 patients had definite esophageal TB, and the median age of patients was 39 years (14–65 years) and 10 (52.6%) patients were female. The most common presenting symptom was dysphagia (n = 16, 84%) followed by odynophagia (n = 8, 42%). On endoscopy, the mid‐esophagus was the most common site of involvement, and findings included ulcers (n = 17), elevated lesions (n = 9), and fistulae (n = 4) in patients. The mediastinal lymphadenopathy was present in all patients, with parenchymal lesions seen in three patients. The endoscopic mucosal biopsies were diagnostic in 11 patients, and in the remaining 8 patients, endoscopic ultrasound‐guided FNAC from the mediastinal lymph nodes was diagnostic. A total of 18 patients completely responded to ATT, and 1 patient had partial response with persistent fistulae requiring additional treatment.ConclusionEsophagus involvement is rare in TB; endoscopic mucosal biopsy and EUS‐guided FNAC is diagnostic, and the response to ATT is excellent.

Gastrointestinal tuberculosis

“…[ 34 36 40 ] It is predominantly secondary to spread from contagious intrathoracic viscera, though primary OTB with isolated esophageal lesions has been described. [ 48 57 58 59 ] The lesions are seen predominantly to involve the middle third of the esophagus in the form of ulcers[ 60 61 ]; rarely, the lesions may be proliferative appearing as malignancy or submucosal growth. [ 48 59 ] Complications in the form of abscesses, stricture, perforation, bleeding and fistulas to adjacent structures like trachea, bronchi, mediastinum and aorta may be the presenting features of OTB.…”

EUS in the diagnosis of pathologically undiagnosed esophageal tuberculosis

“…In summary, there are three types of mode of involvement of ET according to the method of infection [ 3 , 5 ]: Type 1, secondary ET, is the most common type and is often secondary to tuberculosis in adjacent organs and tissues, such as paraesophageal or mediastinal lymph node tuberculosis; paraesophageal lesions of the esophagus have often been missed in the pre-EUS era. Puri R et al [ 16 ] showed that ET was commonly secondary to mediastinal lymph nodal involvement in 32 cases of ET, and EUS showed lymph nodes adjacent to esophageal pathology in all cases.…”

“…Esophageal tuberculosis (ET) is relatively rare, accounting for < 0.2% of all tuberculosis (TB) patients [ 1 – 3 ]. The clinical manifestations are often not specific, including mucosal or submucosal eminence lesions, ulcer, fistula [ 4 ], and others [ 5 ]. A definite diagnosis of ET requires finding acid-fast bacilli or caseous necrotizing granuloma [ 6 ], which is challenging in clinical practice.…”

Clinical Recommendations of the Russian Gastroenterological Association on Diagnosis and Treatment of Infectious Esophagitis

“…Поражение пищевода при туберкулезе наиболее часто наблюдается в грудном отделе и характеризуется наличием вытянутых изъязвлений или специфической инфильтрации стенки [69][70][71][72]. При туберкулезе пищевода эндоскопическая биопсия не всегда информативна в связи с частым распространением патологического процесса из средостения и поражением наружных слоев стенки пищевода.…”