Esophageal tuberculosis: an unusual cause of dysphagia

Tuberculosis presenting as dysphagia: Clinical, endoscopic, radiological and endosonographic features

“…A majority of patients with esophageal tuberculosis have linear ulcerative lesion with or without extrinsic bulge in the mid esophagus as was also in our study 2345678910. The mid esophagus is the most common site of involvement because of its proximity to the hilar and mediastinal lymph nodes surrounding the bifurcation of the trachea 2345678910. The endoscopic mucosal biopsy specimens can help in the diagnosis of esophageal tuberculosis, but one of the study has shown that the diagnostic yield of biopsies obtained after a single endoscopic session was 50% and obtaining biopsies from multiple endoscopic sessions increased the diagnostic yield 9.…”

“…In patients with tuberculosis, dysphagia can occur because of various mechanisms like compression by the surrounding tubercular peri-esophageal lymph nodes, associated mediastinal fibrosis, ulceration and/or polypoidal lesions in the esophagus, or altered motility 2345678910. In our study, a majority of the patients (50%) had dysphagia because of extrinsic compression by the mediastinal lymph nodes whereas 36% patients had dysphagia because of esophageal mucosal involvement.…”

“…Dysphagia as a presenting manifestation of tuberculosis is rare and occurs either due to primary involvement of the esophagus by tuberculosis or secondary to direct extension from adjacent structures like mediastinal or hilar lymph nodes, pulmonary sites, larynx or pharynx or spine 2345678910. Primary esophageal tuberculosis is very rare because of various protective mechanisms like presence of stratified squamous epithelium covered with mucus as well as saliva and rapid transit of luminal contents through the esophagus 2345678910. Hence, most of the cases of esophageal tuberculosis are because of secondary involvement from the surrounding infected structures.…”

An Uncommon Cause of Dysphagia

“…Esophageal involvement was seen in 0.14% of autopsied patients with tuberculosis in one study [1]. Esophageal tuberculosis can be primary or secondary; the latter due to spread from adjacent lymph nodes, lung, spine, or rarely through blood [2]. Primary esophageal tuberculosis is uncommon because of the protective mechanisms like multilayered stratified squamous epithelium along with mucus, saliva, and erect posture causing ingested bacilli in the esophagus to be present only transiently [3].…”

Endosonographic features of esophageal tuberculosis presenting as a subepithelial lesion

“…In an autopsy series of 18 049 patients with tuberculosis, esophageal involvement of tuberculosis was found in only 0.14% of the cases . Esophageal tuberculosis may be primary or secondary, spreading from adjacent lymph nodes, the lungs or, rarely, via the blood . Primary involvement of tuberculosis in the esophagus is not common because of the protective mechanisms such as multilayered stratified squamous epithelium, mucus, saliva, peristalsis and the erect posture, which permits the bacterium to remain in the esophagus only transiently …”