Stenosis of the esophagus - a condition thatis accompanied by a pathological narrowing of the lumen of the esophageal tube. Such an anomaly can be congenital or appear at a more adult age. Disease can lead to a mass of complications. Moreover, the problems with swallowing and passing food into the stomach adversely affect the patient's well-being and the work of the whole organism. So why does this pathology arise and can its development be prevented? What signs should I pay attention to? Are there really effective treatments?
Stenosis of the esophagus: what is it?
As is known, the esophagus is a hollow tube thatconnects the pharynx and stomach. Its average length is 25 cm. Naturally, the diameter of the tube is not the same - the esophagus has three physiological constrictions that are located in the region of the cricoid cartilage, tracheal bifurcation and aperture opening.
In modern gastroenterology is often founda pathology called stenosis of the esophagus. What it is? This pathology, which is accompanied by an uncharacteristic narrowing of the esophageal tube. Since there is a close relationship between this part of the digestive tract and other organs (in particular, the trachea, aorta, pericardium, left bronchus, the trunk of the vagus nerve, the thoracic lymphatic duct, part of the pleura), then the disruption of its operation is associated with a mass of complications.
The main causes of the development of pathology
Are there any risk factors that provokea similar disease? Stenosis of the esophagus can have different causes. If we are talking about congenital forms of the disease, they are associated with a violation of embryonic development, as a result of which there is hypertrophy of the muscular wall of the esophagus, the appearance of fibrous or cartilaginous rings.
As for the acquired stenoses, their causes are much more diverse:
- For example, the mucous membrane may be damaged inthe result of constant contact with the acid content of the stomach. Similar is observed with reflux-esophagitis, peptic ulcers, chronic gastritis, hernia of the esophagus of the diaphragm or even severe toxicosis of pregnant women, if accompanied by frequent vomiting.
- It is worth mentioning about injuries.The most severe esophageal stenosis is observed in burns with chemically aggressive agents, as well as as a result of damage to the wall by a foreign body. You can get injured during various diagnostic procedures, including stomach probing.
- Narrowing or even complete closure of the lumen occurs as a result of esophageal cancer or the appearance of benign tumors.
- Stenosis of the esophagus can be associated with infectious diseases, including mycoses, scarlet fever, syphilis, tuberculosis, diphtheria.
- In some cases, the narrowing of the tube doesassociated with the pathologies of surrounding organs. For example, the esophagus can be squeezed by abnormal vessels or enlarged lymph nodes. Causes include mediastinal tumors and aortic aneurysm.
Forms of stenoses and their features
There are many classification systems for this pathology. For example, esophageal stenosis may be congenital or acquired. By the way, in 90% of cases there is a congenital form of the disease.
Depending on the number of affected areassingle stenoses are isolated (the lumen of the esophagus is narrowed only in one place) and multiple (there are several foci of pathological changes). They also take into account the localization of the narrowing area, dividing the pathology into high stenosis (localized in the cervical region), middle (the narrowed area is located at the level of the trachea bifurcation and aortic arch), low (the pathology center is located in the cardiac department) and combined.
There is a separation by cause of illness.For example, cicatricial stenosis of the esophagus is characterized by damage to the mucous membrane, and sometimes the muscle layer of the tube. In the place of damaged tissues, connective tissue gradually appears - this is how a scar is formed. The cause is usually chronic gastro-esophageal reflux. Sometimes narrowing is associated with the formation and growth of tumors, which can be both benign and malignant. There are also traumatic forms of the disease. In any case, accurately determine the type and characteristics of the disease is possible only after a thorough diagnosis.
Stages of development of the disease
In modern medicine, it is customary to distinguish four degrees of esophageal stenosis:
- In the first stage, the disease is accompanied by a narrowing of the lumen to 9-11 mm in diameter. At the same time through it is quite possible to introduce an endoscope of medium size.
- The second stage is said if the lumen of the esophagus in the area of the stenosis decreases to 6-8 mm. Nevertheless, a fibrobronzoscope can still be inserted through it.
- At the third stage, the esophageal tube narrows and its diameter does not exceed 3-5 mm. Through this site, the doctor can enter only a special, ultra-thin fiberscope.
- The fourth stage of development of the disease is characterized by a strong narrowing of the lumen, its diameter is 1-2 mm. In some patients, there is a complete obstruction of the esophagus, which is very dangerous.
Stenosis of the esophagus: symptoms
The sooner the disorder is diagnosed,the sooner the patient receives the necessary treatment. So what are the signs of esophageal stenosis? Symptoms largely depend on the form and stage of development of the disease.
If we are talking about congenital pathology, the first“Alarm calls” can be noticed almost immediately. After feeding, the baby often spits up with unsalted milk. You can also notice a strong discharge of mucus from the nasal passages, as well as abundant salivation.
In the event that a child has a moderate form of congenital stenosis, problems begin with the introduction of the first complementary foods or solid foods into the diet.
Приобретенная патология развивается постепенно.As a rule, patients have difficulty swallowing. For example, pain during the passage of food through the esophagus, as well as the appearance of pain behind the sternum. In the initial stages, dysphagia is observed when eating solid food, but as the esophageal tube narrows, it becomes difficult for a person to swallow even liquid food. Sometimes the disease becomes so serious that the patient is unable to swallow water or even saliva.
If the stenosis is located in the cervical region, butdrinking liquid or even pieces of food can get into the trachea, which is fraught with a strong cough, laryngospasm, suffocation. In the most severe cases, stenosis leads to the development of aspiration pneumonia.
Often solid and large pieces of food beginaccumulate in the area of constriction, which leads to frequent nausea and vomiting, the appearance of severe pain. Spontaneous ruptures of the esophagus wall can be attributed to the dangerous consequences of stenosis.
Modern diagnostic methods
After a conversation with the patient, the doctor can makesuspected stenosis. Of course, further research is needed further. The first step is to perform an esophagoscopy, with which you can detect a narrowing of the lumen of the esophagus and measure its diameter, as well as inspect the mucous membrane. In the presence of neoplasms or ulcers, an endoscopic biopsy can be performed for the presence of malignant cells.
No less important diagnostic method isradiography using a contrast agent (as a rule, barium salts are used). This procedure helps to explore the topography and contours of the esophagus, as well as to study its motility.
What methods of treatment does modern medicine offer?
The treatment regimen depends on many factors, includingthe form of the pathology, the stage of its development, the condition of the patient, and the causes of stenosis. First you need to change the diet - the diet should consist of semi-liquid and liquid foods that can pass through the site of the narrowing of the esophagus. If we are talking about severe fourth degree dysphagia, when the patient is unable to even take a sip of water, nutrition is administered intravenously.
There are several methods to eliminate the narrowing.In milder cases, balloon dilatation is performed using bougie. But if stenosis is not amenable to similar methods of expansion, endoscopic dissection of strictures is performed. In the event that there is squeezing of the esophagus (for example, narrowing it near the growing tumor), then a special stent can be inserted into the lumen, which will maintain the desired size of the esophagus.
Sometimes it happens that the abovemethods do not give the desired result, stenosis continues to progress. The doctor may decide on a more radical solution - the removal of the affected part of the esophagus with its subsequent restoration.
Is treatment by folk methods possible?
Traditional medicine is the industry that offersa huge number of alternative treatments. Is it possible to get rid of a disease such as esophageal stenosis with their help? Treatment of folk remedies in this case is unacceptable. It is possible that the doctor will recommend correcting the diet or give some other instructions. Home therapy in this case is absolutely contraindicated.
Are there effective preventive measures?
Unfortunately, really effectiveprophylactic agents do not exist. With regard to congenital forms, it is important for the mother to monitor the state of health. If there are risk factors (infection carried during pregnancy, etc.), the examination should be carried out in the first days after the birth of the child in order to be able to adjust the diet and take safety measures in time.
As an adult, the patient is advised to follow the diet, as well as to treat the diseases of the digestive tract in time, preventing them from becoming more severe or chronic.
Prognosis for patients with stenosis of the esophagus
In the absence of timely treatment of stenosisesophagus can lead to a host of complications. Nevertheless, surgical intervention can eliminate the violation. Of course, in the presence of comorbidities, additional therapy is needed. Nevertheless, the prognosis for the patient is quite favorable. Relapse is possible, but, according to statistics, such cases are an exception and are recorded very rarely.
