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Esophageal syphilis
Last reviewed: 07.07.2025
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Syphilis of the esophagus is a disease that is not so common, occurring in all stages of this venereal disease, but most often manifesting itself in the tertiary period.
Pathologically, syphilis of the esophagus manifests itself in two forms - ulcerative and gummatous, which are very similar to the changes that occur with syphilis of the pharynx and larynx. Most often, the upper sections of the esophagus are affected, where the infectious process penetrates from the pharynx. The resulting gumma takes the form of a diffuse infiltrate or tumor, which cause annular stenosis of the esophagus. When these formations soften, ulcers appear that look like stamped notches in the mucous membrane with raised edges, some of which tend to spread over the surface, some - to affect the entire thickness of the esophagus wall with the formation of its perforations. The latter can spread to neighboring organs with the formation of esophageal-tracheal or esophageal-bronchial communications (fistulas).
Symptoms of esophageal syphilis
The first symptoms of syphilitic esophageal lesions usually appear many years after the initial infection. Esophageal syphilis is usually not diagnosed immediately, but only after the signs of dysphagia appear. Most often, with esophageal syphilis, there is a suspicion of the presence of an oncological disease of the esophagus. Since almost all forms of esophageal syphilis have a pronounced tendency to sclerosis of its wall and the formation of strictures, the earliest and most common symptoms of 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 esophageal obstruction occurs suddenly, seemingly in the midst of the patient's complete health. The disease proceeds almost without pain syndrome, only with the addition of a secondary infection in the area of the disintegrating gumma can moderate pain occur when swallowing, localized behind the sternum and in the upper parts of the esophagus.
Diagnosis of esophageal syphilis
In recognizing esophageal syphilis, anamnesis with indication of the fact of syphilis in the past plays a major role. Such anamnestic facts as spontaneous miscarriages, premature births and a number of specific symptoms indicating the presence of syphilitic infection in the past are also important. Esophageal X-ray data are not pathognomonic.
Esophagoscopy reveals ulcers, gummatous infiltrates, strictures and star-shaped scars. Ulcers usually do not bleed and are not painful when touched with a biopsy instrument. The last two signs are very typical of esophageal syphilis. In the presence of an esophageal-tracheal fistula, sometimes poorly visualized due to the gummatous tissue hanging over it, Gerhard's symptom may appear - air entering the trachea from the esophagus, especially when trying to exhale with closed lips and overlapping the nasopharynx with the 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. In differential diagnosis, tuberculosis and some tumors should be taken into account. The prognosis is determined by the timely detection of esophageal syphilis and the degree of development of the general syphilitic infection, as well as timely and high-quality etiologic treatment. In the case of esophageal-tracheal fistulas, the prognosis is aggravated by possible aspiration pneumonia, bronchitis of both specific and banal etiology. In the case of fistulas penetrating the mediastinum, the prognosis is serious due to the possibility of purulent mediastinitis.
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Treatment of esophageal syphilis
Treatment of esophageal syphilis is general and specific. In case of esophageal perforations and fistulas, attempts are made to plastically close the defects of the walls of both the trachea (bronchus) and the esophagus. In case of mediastitis, as the last chance to save the patient, mediastinotomy is performed against the background of intensive antibiotic and other therapy. In case of sclerotic stenosis, bougienage is performed.