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Lues Of The Esophagus





Category: DISEASES OF THE ESOPHAGUS
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery

Esophageal syphilis is a rather rare affection, and may show itself
as a mucous plaque, a gumma, an ulceration, or a cicatrix. Cicatricial
stenosis developing late in life without history of the swallowing of
escharotics or ulcerative lesions is strongly suggestive of syphilis,
though the late manifestation of a congenital stenosis is a
possibility.

Esophagoscopic appearances of lues are not always characteristic. As
in any ulcerative lesion, the inflammatory changes of mixed infections
mask the basic nature. The mucous plaque has the same appearance as
one situated on the velum, and gummata resemble those seen in the
mucosa elsewhere. There is nothing characteristic in luetic
cicatrices.

The diagnosis of luetic lesions of the esophagus, therefore, depends
upon the history, presence of luetic lesions elsewhere, the serologic
reaction, therapeutic test, examination of tissue, and the
demonstration of the treponema pallidum. The therapeutic test by
prolonged saturation of the system with mercury is imperative in all
suspected cases and no other negative result should be deemed
sufficient.

The treatment of luetic esophagitis is systemic, not local. Luetic
cicatrices contract strongly, and are very resistant to treatment, so
that esophagoscopic bouginage should be begun as early as possible
after the healing of a luetic ulceration, in order to prevent
stenosis. A silk-woven endoscopic bougie placed in position by ocular
guidance, and left in situ for from half to one hour daily, may
prevent severe contraction, if used early in the stage of
cicatrization. Prolonged treatment is required for the cure of
established luetic cicatricial stenosis. If gastrostomy has been done
retrograde bouginage (Fig. 35) may be used.




Next: Tuberculosis Of The Esophagus

Previous: Paralysis Of The Esophagus



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