Lues Of The Esophagus

Categories: DISEASES OF THE ESOPHAGUS
Sources: 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 charac eristic. 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.