Stenosis of the esophagus is a condition that is accompanied by a pathological narrowing of the lumen of the esophageal tube. Such an anomaly may be congenital or appear at an older age. The disease can lead to many complications. Moreover, problems with swallowing and passing food into the stomach negatively affect the patient's well-being and the functioning of the whole organism. So why does this pathology occur and can its development be prevented? What are the signs to look out for? Are there really effective treatments?
Esophageal stenosis: what is it?
As you know, the esophagus is a hollow tube that connects 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, which are located in the area of the cricoid cartilage, the bifurcation of the trachea and the opening of the diaphragm.
In modern gastroenterology, a pathology called esophageal stenosis is common. What it is? This is a pathology that is accompanied by an uncharacteristic narrowing of the esophageal tube. Because there is a close relationshipbetween this part of the digestive tract and other organs (in particular, the trachea, aorta, pericardium, left bronchus, vagus nerve trunk, thoracic lymphatic duct, part of the pleura), then a violation of its work is associated with a lot of complications.
Main causes of pathology
Are there any risk factors that provoke such a disease? Esophageal stenosis can have different causes. If we are talking about congenital forms of the disease, then they are associated with impaired embryonic development, resulting in hypertrophy of the muscular wall of the esophagus, the appearance of fibrous or cartilaginous rings.
As for acquired stenoses, their causes are much more diverse:
- For example, the mucous membrane can be damaged as a result of constant contact with the acidic contents of the stomach. This is observed with reflux esophagitis, peptic ulcers, chronic gastritis, hiatal hernia, or even severe toxicosis of pregnant women, if it is accompanied by frequent vomiting.
- It is worth mentioning the injuries. The most severe stenoses of the esophagus are observed with burns by chemically aggressive agents, as well as as a result of damage to the wall by a foreign body. It is possible to get injured during various diagnostic procedures, including gastric sounding.
- Narrowing or even complete closure of the lumen occurs as a result of cancer of the esophagus or the appearance of benign neoplasms.
- Stenosis of the esophagus may be associated with infectious diseases, including fungal infections,scarlet fever, syphilis, tuberculosis, diphtheria.
- In some cases, the narrowing of the tube is completely associated with pathologies of the surrounding organs. For example, the esophagus may be compressed by abnormally located vessels or enlarged lymph nodes. Causes include mediastinal tumors and aortic aneurysms.
Forms of stenoses and their features
There are many classification systems for this pathology. For example, esophageal stenosis can be congenital or acquired. By the way, in 90% of cases it is the congenital form of the disease that occurs.
Depending on the number of affected areas, single stenosis is distinguished (the lumen of the esophagus is narrowed in only one place) and multiple (there are several foci of pathological changes). The localization of the site of narrowing is also taken into account, dividing the pathology into high stenosis (located in the cervical region), medium (the narrowed site is located at the level of the bifurcation of the trachea and aortic arch), low (the focus of pathology is located in the cardiac region) and combined.
There is also a division according to the causes of the disease. For example, cicatricial stenosis of the esophagus is characterized by damage to the mucous membrane, and sometimes the muscle layer of the tube. In place of damaged tissues, connective tissue gradually appears - this is how a scar is formed. The cause is usually chronic gastroesophageal reflux. Sometimes the narrowing is associated with the formation and growth of tumors, which can be either benign or malignant. There are also traumatic forms of the disease. ATin any case, it is possible to accurately determine the type and characteristics of the disease only after a thorough diagnosis.
Stages of disease progression
In modern medicine, it is customary to distinguish four degrees of esophageal stenosis:
- At the first stage, the disease is accompanied by a narrowing of the lumen to 9-11 mm in diameter. At the same time, it is quite possible to insert a medium-sized endoscope through it.
- The second stage is said in the event that the diameter of the lumen of the esophagus at the site of stenosis decreases to 6-8 mm. However, a fibrobronscope 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 area, the doctor can only insert a special, ultra-thin fiberscope.
- The fourth stage of the development of the disease is characterized by a strong narrowing of the lumen, its diameter is 1-2 mm. Some patients have a complete blockage of the esophagus, which is very dangerous.
Stenosis of the esophagus: symptoms
The sooner the disorder is diagnosed, the sooner the patient will receive the necessary treatment. So what are the symptoms of esophageal stenosis? Symptoms largely depend on the form and stage of development of the disease.
If we are talking about congenital pathology, then the first “alarm bells” can be noticed almost immediately. After feeding, the baby often spits up uncured milk. You may also notice a strong discharge of mucus from the nasal passages, as well as profuse salivation.
In the event that the child has a moderate form of congenitalstenosis, problems begin with the introduction of the first complementary foods or solid foods.
Acquired pathology develops gradually. As a rule, patients have difficulty swallowing. For example, pain may occur 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 severe that the patient is unable to swallow water or even saliva.
If the stenosis is located in the cervical region, but drunk liquid or even pieces of food can enter the trachea, which is fraught with severe cough, laryngospasm, suffocation. In the most severe cases, stenosis leads to aspiration pneumonia.
Often, hard and large pieces of food begin to accumulate in the area of narrowing, which leads to frequent nausea and vomiting, the appearance of severe pain. The dangerous consequences of stenosis include spontaneous ruptures of the esophageal wall.
Modern diagnostic methods
Already after talking with the patient, the doctor may express suspicions about the presence of stenosis. Of course, more research is needed in the future. First of all, you need to carry out esophagoscopy, with which you can detect the narrowing of the lumen of the esophagus and measure its diameter, as well as examine the mucous membrane. In the presence of neoplasms or ulcers, an endoscopic biopsy may be performed to look for malignantcells.
An equally important diagnostic method is radiography using a contrast agent (as a rule, barium s alts are used). This procedure helps to examine the relief and contours of the esophagus, as well as to study its peristalsis.
What treatments does modern medicine offer?
The treatment regimen depends on many factors, including the form of pathology, the stage of its development, the patient's condition, and the causes of stenosis. First you need to change the diet - the diet should consist of semi-liquid and liquid food, which can pass through the narrowing of the esophagus. If we are talking about severe dysphagia of the fourth degree, when the patient is not even able to take a sip of water, nutrition is administered intravenously.
There are several methods to eliminate the constriction. In milder cases, balloon dilatation is performed using bougies. But if the stenosis does not lend itself to such methods of expansion, an endoscopic dissection of the strictures is performed. In the event that there is compression of the esophagus (for example, its narrowing near a growing tumor), then a special stent can be inserted into the lumen, which will maintain the required dimensions of the esophagus.
Sometimes it happens that the above methods do not give the desired result, the stenosis continues to progress. The doctor may decide on a more radical solution - removal of the affected part of the esophagus and its subsequent restoration.
Is it possible to treat folk methods?
Traditional medicine is an industry thatoffers a wide range of alternative therapies. Is it possible to get rid of such a disease as stenosis of the esophagus with their help? Treatment with folk remedies in this case is unacceptable. It is possible that the doctor will recommend adjusting the diet or give some other instructions. Home therapy in this case is categorically contraindicated.
Are there effective preventive measures?
Unfortunately, there are no really effective preventive measures. As for congenital forms, it is important for the mother to monitor the state of he alth. In the presence of risk factors (an infection transferred 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.
In adulthood, the patient is recommended to monitor nutrition, as well as to treat diseases of the digestive tract in time, preventing them from becoming more severe or chronic.
Prognosis for patients with esophageal stenosis
If left untreated, esophageal stenosis can lead to a host of complications. Nevertheless, surgical intervention can eliminate the violation. Of course, in the presence of concomitant diseases, additional therapy is necessary. Nevertheless, the prognosis for the patient is quite favorable. Relapse is possible, but, according to statistics, such cases are an exception and are extremely rare.
