Esophageal Tuberculosis

Abstract

Esophageal tuberculosis is an uncommon manifestation of tuberculosis. It is an important cause of dysphagia in endemic regions and affects both genders equally. Primary involvement of the esophagus is less common. Secondary esophageal tuberculosis is usually due to esophageal involvement by the mediastinal lymph nodal tuberculosis. Dysphagia is the most common symptom followed by retrosternal pain and odynophagia. Hematemesis, although uncommon, may suggest aorto-esophageal fistula. Constitutional symptoms like weight loss, fever are seen in one-fourth of patients. Endoscopy with biopsy is the mainstay for diagnosis. Ulcer is the most common finding followed by bulge with summit ulcer which is the hallmark finding. Mid-esophagus is the most commonly involved site but the disease can involve any portion of esophagus. Endosonography has enhanced the diagnostic capability and fine-needle aspiration for cytological or histological evaluation can be done. Endoscopic ultrasound is especially useful in submucosal lesions. Esophageal tuberculosis may be complicated by fistulous communications with trachea, aorta, and skin. Antitubercular multidrug therapy is the mainstay of therapy. Sometimes additional surgical or endoscopic interventions might be warranted for the complications. Overall, esophageal tuberculosis has a good outcome with a cure rate of 92%.