radiation esophagitis
Introduction
Introduction to radiation esophagitis Radiotherapy, abbreviated as radiotherapy, is widely used in the treatment of malignant tumors of the mediastinum of the thoracic cavity. However, due to the ionization effect of radiation on the organism, normal tissues and cells may be damaged and destroyed. Because the squamous epithelium of the esophagus is sensitive to radioactive materials, radioactive esophageal damage may occur during radiotherapy, especially when radiotherapy and chemotherapy are performed simultaneously. This type of esophageal damage caused by radiation is called radioactive esophagitis. basic knowledge The proportion of illness: the incidence rate is about 0.004%-0.008% Susceptible people: no special people Mode of infection: non-infectious Complications: esophageal cancer
Cause
Causes of radiation esophagitis
Tumor radiotherapy (40%):
Radioactive esophagitis often occurs during or after radiotherapy for lung cancer and mediastinal chest malignancies, sometimes indirectly in radiotherapy of oropharyngeal malignant tumors. Radiotherapy greater than 30 Gy can cause damage to the esophageal neuromuscular, resulting in weakened esophageal peristalsis, even Disappeared, with the increase of radiation dose, the heavier esophageal injury, the ionization of radiation itself can cause damage and necrosis of esophageal epithelial cells. On this basis, due to the slowing of esophageal peristalsis, the harmful substances pass through the esophagus time, which is aggravated. This damage.
Low immunity (20%):
Radiotherapy can cause the body's white blood cells to decrease, the body's immunity is reduced, causing esophageal infection, and there is an inflammatory change of the esophagus. This is related to the atrophy of the salivary glands caused by radiation, and the extreme decrease of salivation. Saliva is an effective substance for neutralizing gastric acid and protecting the esophageal mucosa. The weak acid-resistance barrier can cause the damage factor to act stronger than the protective factor, thereby causing reflux esophagitis.
Radiation (30%):
Radiation can cause ionization of living organisms and cause a series of pathophysiological reactions, destroying and damaging tissue cells. About 50% to 70% of patients receiving radiation develop nausea, vomiting, chest pain, fever, fatigue and other symptoms within a few minutes. .
Pathological staging
(1) Necrotic phase: After the esophagus is irradiated by radiation, the basal cells stop dividing, and soon there is degeneration and necrosis, submucosal edema, vasodilation, and epithelial shedding. At this stage, the esophageal mucosa appears to be hyperemia, edema, erosion, and ulceration.
(2) Withering period: After a few weeks of radiotherapy, the necrotic tissue is detached, the wall of the tube becomes thinner, and the mucosa becomes smooth. Some patients may still have obvious esophageal smooth muscle abnormality. In this stage, esophageal hemorrhage and perforation are prone to occur.
(3) Regeneration period: After several months of radiotherapy, the remaining cells in the basal layer begin to regenerate, gradually extend upward, migrate, and the surface layer re-covers the neonatal epithelial cells. In this period, due to radiation-induced vascular and tissue damage, fibrosis gradually appears, esophagus It is thin, narrow, and the esophageal dyskinesia is aggravated.
Prevention
Radioactive esophagitis prevention
Some people think that patients receiving high-dose radiotherapy may have attenuated adrenal function. Therefore, patients with radiation esophagitis may consider using glucocorticoids to reduce radiation damage and improve the course of disease.
Complication
Radioactive esophagitis complications Complications Esophageal cancer
Such as patients with persistent severe sternal pain, fever, pulse speed, etc., should be alert to esophageal perforation, need to be further examined and properly treated, esophageal cancer patients with esophageal perforation after radiotherapy, hemorrhage and fistula, not all radioactive esophagitis It may be the result of withdrawal after tumor invasion and radiotherapy.
Symptom
Radioactive esophageal symptoms Common symptoms Post-sternal pain, fever, severe pain, esophageal trachea, dyspnea, esophageal mucosal edema, congestion
Typical symptoms of radiation esophagitis, such as swallowing pain or post-sternal pain, usually occur within 1 week or weeks after radiotherapy. The general symptoms are mild. In severe cases, chest pain, fever, cough, difficulty breathing, vomiting may occur. , hematemesis, etc., should be alert to the occurrence of esophageal perforation or esophageal fistula.
Examine
Radioactive esophagitis examination
A routine laboratory test with diagnostic significance is a white blood cell count that can be reduced.
1. Early symptomatic patients, esophageal swallowing examination showed that the peristaltic wave was weakened, esophageal ulcer, etc., and esophageal stricture was seen in the late stage.
2. Esophagoscopy can be seen in the esophageal mucosa with or without congestion, ulcers, tumors, varicose veins, stenosis, dilatation, etc., to see the performance of esophagitis in different periods.
Diagnosis
Diagnosis and diagnosis of radiation esophagitis
According to the patient's history and symptoms of radiotherapy, the diagnosis is not difficult. In the early symptoms, the esophageal swallowing examination can be seen that the peristaltic wave is weakened, the esophageal ulcer is observed, and the esophageal stenosis can be seen in the late stage. Esophagoscopy can be seen in different periods of esophagitis.
Differential diagnosis
1. Suppurative esophagitis: Suppurative esophagitis is the most common mechanical damage caused by foreign bodies. The bacteria multiply in the esophageal wall, causing local inflammatory exudation, different degrees of tissue necrosis and pus formation, and can also be more extensive. cellulitis.
2. Esophageal tuberculosis: Esophageal tuberculosis patients generally have other pioneer symptoms of tuberculosis, especially tuberculosis. The symptoms of esophagus are often confused or concealed by other organ symptoms, so that they cannot be discovered in time. According to the pathological process of tuberculosis, the early stage of infiltration can be advanced. There are symptoms of fatigue, low fever, increased erythrocyte sedimentation rate, but also symptoms are not obvious, followed by swallowing discomfort and progressive dysphagia, often accompanied by persistent throat and retrosternal pain, aggravation when swallowing, ulcer-type lesions Most of them are characterized by pain when swallowing. Food spilling into the trachea should consider the formation of tracheal esophageal fistula. Difficulty in swallowing suggests that the fibrosis of the lesion causes scarring.
3. Fungal esophagitis: The clinical symptoms of fungal esophagitis are atypical. Some patients may have no clinical symptoms. Common symptoms are swallowing pain, difficulty swallowing, upper abdominal discomfort, post-sternal pain and burning sensation. It is like a knife-like colic, which can radiate to the back like angina. Candida esophagitis can cause severe bleeding but is not common. Untreated patients may have epithelial shedding, perforation or even disseminated candidiasis, and esophageal perforation can cause Mediastinal inflammation, esophageal tracheal fistula and esophageal stricture, patients with persistent high fever granulocytopenia should be checked for skin, liver, spleen, lung and other disseminated acute candidiasis.
4. Viral esophagitis: HSV infection of the esophagus often has nasal and herpes labia. The main symptom is swallowing pain. The pain is often aggravated when swallowing food. The patient's food is slow in the esophagus after swallowing. A few patients have difficulty swallowing. The main symptoms, mild infection can be asymptomatic.
