Esophageal cast
Introduction
Introduction to esophageal tube type Esophageal cast (esophagealcast), superficial exfoliative esophagitis (superficial exfoliativeoesophagitis), idiopathic esophageal mucosal exfoliation (spontaneous intramural rupture of theesophagus), traumatic esophageal mucosal epithelial exfoliation and other disease names. basic knowledge The proportion of illness: 0.0002% Susceptible people: no special people Mode of infection: non-infectious Complications: reflux esophagitis
Cause
Esophageal tube type etiology
Causes:
It is generally believed that the esophageal tube type is an unexplained hyperplasia of the esophageal epithelium. For some reason, vomiting or after mild mucosal injury, the mucosa is gradually separated completely, forming a tube type shedding, and the esophageal tube type can occur without infection. Normal healthy people without chemical burns, due to mild esophageal mucosal injury, hot drinks, foreign bodies, frequent vomiting and other causes, Zhang Taichang et al reported 2 cases of esophageal cast are caused by frequent vomiting, in recent years, some scholars have proposed esophagus The tube type is related to the high pressure area of the lower esophagus. Due to the pressure of this section, part of the gas in the esophageal lumen is squeezed into the submucosal layer of the damaged part. When accompanied by severe vomiting, the mucosa is promoted under the influence of relevant airflow mechanics factors. The surface peeling surface spreads evenly and rapidly to the entire length of the esophagus to form a complete esophageal cast type, which is spit out with vomiting.
Pathogenesis:
The esophageal tube type has only the epithelial layer in the structure, and the exfoliated surface is the submucosa of the mucosa. It is a normal esophageal mucosa and a squamous epithelial structure, so it can be quickly recovered without causing esophageal stenosis. Some scholars believe that under the microscope, the cell plasma is lightly stained. The cell boundary is unclear, the nucleus is mostly round, some cells are degenerative changes, and some capillary epithelial cells proliferate.
Prevention
Esophageal tube type prevention
Pay attention to avoid rough, overheated foods, avoid eating too fast, avoid or prevent frequent vomiting, it is important to prevent this disease.
1. Develop good eating habits: Do not make trouble when eating, avoid dry or hard food or sharp foreign body when you swallow the esophageal mucosa.
2. Avoid iatrogenic esophageal mucosal damage during esophagoscopy or gastroscopy. Especially the elderly and young children.
3. Usually eat easily digestible foods, such as porridge, clear soup and so on.
4. Develop good habits. Moxibustion Zusanli and Liangmen points. In addition, a large number of clinical and experimental studies have shown that acupuncture may pass through the hypothalamus and certain gastrointestinal hormones and neuropeptides. Timely supplement with various nutrients.
Complication
Esophageal tube complications Complications, reflux esophagitis
Most patients only discharge one tube type, rarely relapse. Some people think that it is related to the change of desmosomes between cells. When the patient vomits blood, he can give hemostasis, if necessary, transfusion. To prevent and treat infection, antibiotics can be added. There are few complications.
Symptom
Esophageal tube symptoms common symptoms pharyngeal foreign body sensation upper abdominal pain mouth and throat burning sensation suffocation chest tightness
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.
Examine
Esophageal tube type examination
Histological examination showed stratified squamous epithelium, no obvious inflammation, no necrotizing lesions, but degenerative changes, in a few cases, cytoplasmic edema vacuoles in the basal cell layer, nuclear pyknosis, due to basal cell abnormalities The epithelial bullae are formed, so that the cohesive force between the epithelium and the underlying tissue disappears, so that the cast is peeled off.
Diagnosis
Esophageal tube type diagnosis
diagnosis
Diagnosis is based on clinical manifestations.
Differential diagnosis
1. Esophageal pemphigus:
Characteristic endoscopic findings are the formation of blister, because it is easy to rupture, not often seen, more reports of edema, redness, erosion, ulcers and other non-specific inflammatory findings, and the identification of reflux esophagitis is very difficult, the lesion involves In the middle and upper esophagus, all vascular permeability is low, line and map-like, round and other kinds of erosive ulcers can be used as identification points. 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, and complex genetic conditions in which the blistering of the recessive dystrophic bullous epidermolysis It is characterized by loose blisters, thin and easy to rupture, mostly serous, and may also be accompanied by hemorrhagic bullae. It can occur in any part of the skin. Mucosa is often involved, large blisters, erosion, and can also occur in the esophagus. Mucosa.
3. Pemphigus dermatitis:
Pemphigoid dermatitis is inflammation, blisters and bullae that occur in the mucosa and skin of the conjunctiva, mouth, nose, trachea, esophagus, glans, female genitals, urethra, vagina and anus. After the healing, scars remain on the mucosa. If the blister and blisters in the oral and esophageal mucosa occur, the blistering and erosion often lead to scar formation, and very few people may have esophageal stenosis.
