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Syphilis of the esophagus
Last reviewed: 23.04.2024
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Syphilis of the esophagus - the disease is not so frequent, occurs in all stages of this venereal disease, but is most often manifested in the Tertiary period.
Pathomorphologically, the esophagus syphilis manifests itself in two forms - ulcerous and gummy, which are very similar to those that occur with syphilis of the pharynx and larynx. Most often, the upper parts of the esophagus are affected, where the infectious process penetrates from the pharynx. The resulting gum takes the form of a diffuse infiltrate or tumor, which causes a ring stenosis of the esophagus. When these formations soften, ulcers appear that have the form of stamped felling in the mucosa with raised edges, some of which tend to spread along the surface, some to the destruction of the entire thickness of the esophageal wall with the formation of its perforations. The latter can spread to neighboring organs with the formation of esophageal-tracheal or esophageal-bronchial messages (fistula).
Symptoms of syphilis of the esophagus
The first symptoms of syphilitic infection of the esophagus, as a rule, appear many years after the primary infection with this infection. Usually syphilis of the esophagus is diagnosed not immediately, but only after the appearance of signs of dysphagia. Most often with syphilis of the esophagus there is a suspicion of the presence of an oncological disease of the esophagus. Since almost all forms of syphilis of the esophagus have a pronounced tendency to sclerosis of its wall and the formation of strictures, the earliest and frequent symptoms in this disease are dysphagia and difficulty in passing food through the esophagus. These signs progress gradually, stenosis of the esophagus develops slowly. Occasionally the symptom of the obstruction of the esophagus arises suddenly, it would seem, among the patient's overall health. The disease proceeds almost without pain syndrome, only when secondary infection is attached to the disintegrating gum can moderate pains occur when swallowing, located behind the breastbone and upper parts of the esophagus.
Diagnosis of esophagus syphilis
In the recognition of syphilis of the esophagus, an important role is played by an anamnesis indicating the fact of syphilis in the past. There are also important anamnestic facts such as spontaneous abortions, premature births and a number of specific symptoms that indicate the presence of a syphilitic infection in the past. X-ray data of the esophagus are not pathognomonic.
With esophagoscopy, ulcers, gummy infiltrates, strictures and star-shaped scars are found. Ulcers usually do not bleed and are not painful when touched by a biopsy instrument. The last two signs are very characteristic for the esophagus syphilis. In the presence of esophageal and tracheal fistula, sometimes poorly visualized due to overhanging hummoxic tissue, Gerhardt's symptom may appear - air entering from the trachea into the esophagus, especially when trying to exhale with closed lips and overlapping the nasopharynx with a soft palate (straining). The final diagnosis is established with positive serological tests, but some of them may be negative, which does not exclude the presence of this disease. When differential diagnosis should be borne in mind tuberculosis and some tumors. The prognosis is determined by the timely detection of the esophagus syphilis and the degree of development of the common syphilitic infection, as well as timely and qualitative etiological treatment. With the formation of esophageal-tracheal fistula, the prognosis is aggravated by possible aspiration pneumonia, bronchitis of both specific and common etiology. With fistulas penetrating the mediastinum, the prognosis is serious because of the possibility of a purulent mediastinitis.
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Treatment of syphilis of the esophagus
Treatment of syphilis of the esophagus is general specific. At perforations of the esophagus and his fistula, attempts are made to plasticly close the defects of the walls like the trachea (bronchus) and esophagus. With mediastipite, as a last chance to save a patient, mediastinotomy is undertaken against a background of intensive antibiotic and other therapy. In sclerotic stenoses, the bougie is carried out.