Esophageal stricture
Introduction
Introduction to esophageal stricture Stenosis of theesophagus can be divided into congenital and acquired, with esophageal dilation and hypertrophy above the stenosis. It is very rare in the clinic, more than the onset of childhood, often requires surgery. Clinical attention should be paid to the difference between secondary esophageal stricture. Congenitalesophagostenosis (CES) refers to the abnormal shape of the esophageal wall structure that is already present after birth. The characteristic manifestation is food reflux after eating, and the symptoms are more obvious when ingesting semi-solid or solid food. The reflux is mainly saliva and indigestible milk or food, which is neither sour nor bile. The patient may have cough or blemishes. Older children are forced to breathe by pressing the trachea or bronchi. basic knowledge The proportion of illness: 0.05--0.1% Susceptible people: no special people Mode of infection: non-infectious Complications: pneumonia
Cause
Causes of esophageal stricture
Congenital factors (30%):
During the development of esophageal embryos, the results of excessive proliferation of the mesoderm components in the trachea, esophageal septum or esophageal sacral tract occur mostly in the position below the tracheal bifurcation.
Acquired chemical factors (30%):
The esophageal mucosa epithelium is damaged by inflammation or chemical corrosion, and scarring is formed after repair;
Disease factor (30%):
Esophageal tumors such as esophageal cancer block the esophageal lumen to varying degrees; lesions around the esophagus are caused by external compression of the esophagus, such as lung and mediastinal tumors, aneurysms, goiters, etc.
Prevention
Esophageal stricture prevention
1. Adjust daily life and workload, and regularly carry out activities and exercise to avoid fatigue.
2. Maintain emotional stability and avoid emotional excitement and tension. 3. Keep the stool smooth, avoid using stools, eat more fruits and high-fiber foods. 4. Avoid cold irritation and keep warm.Complication
Esophageal stricture complications Complications pneumonia
Reflux food and saliva can enter the trachea, causing inhaled bronchitis or pneumonia due to food reflux after feeding or eating.
Symptom
Esophageal stricture symptoms common symptoms esophageal reflux symptoms cough and sputum
Congenital esophageal stricture is characterized by food reflux after eating, and the symptoms are more pronounced when ingesting semi-solid or solid foods. The reflux is mainly saliva and indigestible milk or food, which is neither sour nor bile. The reflux food enters the trachea and the patient may have cough or blemishes. Some elderly children, due to abnormal enlargement of the proximal esophagus, become a pocket of food, which can compress the trachea or bronchi and produce wheezing.
Physical examination: no special pathological signs, some patients may have malnutrition or anemia.
Examine
Esophageal stricture examination
Laboratory inspection
Feasible 24h esophageal pH monitoring, if necessary, take the esophageal mucosal living tissue for pathological examination to aid diagnosis.
Auxiliary inspection
1. Esophageal barium meal angiography According to the imaging characteristics of barium meal angiography, esophageal stenosis can be divided into two types.
(1) Long-segment type: stenosis occurs in the lower part of the esophagus and is about several centimeters long. The narrow margin is not smooth, the esophagus is dilated above the stenosis, and the expectorant is slow, showing reverse peristalsis (Figure 2). This type of clinical symptoms appear earlier, similar to reflux esophagitis, X-ray is difficult to identify.
(2) short segment type: often occurs in the middle and lower part of the esophagus, the narrow segment is about several millimeters to 1 cm long, the edge is smooth, and the mucosa is regular. The esophagus was slightly dilated above the stenosis, the expectorant was down, and the distal esophagus was normal. Sometimes foreign matter or food blocks are likely to persist on the stenosis. The narrow segment cannot expand. This disease is often associated with aspiration pneumonia, routine chest X-ray examination.
2. Esophagoscopy pediatric microscopy provides a primary objective basis for the nature of the stenosis.
3. Esophageal pressure measurement.
Diagnosis
Diagnosis and differentiation of esophageal stricture
Children repeatedly have food reflux or cough after meal, and older children have a post-meal wheezing performance, which should be highly suspected. X-ray esophageal barium meal and esophagoscopy showed esophageal stricture or membranous fistula, which can be diagnosed.
Differential diagnosis
X-ray examination is the main basis for the diagnosis of this disease, and its image needs to be identified with the following diseases:
1. The stenosis of the achalasia is located in the Tuen Mun. It is intermittently open, and the expectorant can be sprayed into the stomach. Congenital esophageal stricture is a persistent stenosis with no open jet signs, but the expectorant can continue to pass. Usually the esophageal dilatation above the stenosis is not as obvious as the achalasia.
2. Congenital reflux esophagitis in the stenosis of the esophagus is not smooth, uneven, mucosal destruction or sputum, sometimes visible esophageal hiatus hernia. In the follow-up observation, the degree of stenosis can be aggravated and lengthened. Clinical symptoms are also aggravated.
