Esophageal stenosis: causes, symptoms, treatment

Stenosis of the esophagus - a condition that is 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, problems with swallowing and passing food into the stomach have a negative effect on 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 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 region of the cricoid cartilage, tracheal bifurcation and aperture opening.

In modern gastroenterology, a pathology called stenosis of the esophagus is common. 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 provoke such a 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, the reasons for them are much more diverse:

• For example, the mucous membrane can be damaged by 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 stenosis of the esophagus is observed with burns chemically aggressive means, 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 sensing.
• The narrowing or even complete closure of the lumen appears as a result of cancer of the esophagus or the appearance of benign neoplasms.
• Stenosis of the esophagus can be associated with infectious diseases, including mycosis, scarlet fever, syphilis, tuberculosis, diphtheria.
• In some cases, the narrowing of the tube and is at all associated with the pathology of the surrounding organs. For example, the esophagus can be squeezed by abnormally located vessels or enlarged lymph nodes. To the reasons it is possible to carry a tumor of a mediastinum and an aneurysm of an aorta.

Forms of stenosis and their features

There are many classification systems of this pathology. For example, stenosis of the esophagus 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 stenoses are isolated (the lumen of the esophagus is narrowed only in one place) and multiple (there are several foci of pathological changes). Take into account the localization of the narrowing site, dividing the pathology into high stenosis (localized in the cervical region), the middle (narrowed section is located at the level of the bifurcation of the trachea and the arch of the aorta), low (the focus of the pathology is located in the cardiac department) and combined.

There is also a division for reasons 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. On the site of damaged tissue gradually appears connective tissue - this is how the scar is formed. The cause, as a rule, is chronic gastroesophageal reflux. Sometimes narrowing is associated with the formation and growth of tumors, which can be both good and malignant. There are also traumatic forms of the disease. In any case, it is possible to determine precisely the variety and features of the disease only after careful diagnosis.

Stages of development of the disease

In modern medicine, it is common to distinguish four degrees of stenosis of the esophagus:

• At the first stage, the disease is accompanied by a narrowing of the lumen to 9-11 mm in diameter. Thus through it it is quite possible to enter an endoscope of the average size.
• About the second stage speak in the event that the diameter of the lumen of the esophagus in the place of stenosis decreases to 6-8 mm. Nevertheless, it is still possible to introduce a fibrobronoscope through it.
• In 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 fibroscope.
• 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 complete blockage of the esophagus, which is very dangerous.

Esophagus stenosis: symptoms

The earlier the disorder is diagnosed, the faster the patient will receive the necessary treatment. So what are the signs of stenosis of the esophagus? Symptoms largely depend on the form and stage of the development of the disease.

If it is a question of congenital pathology, then the first "alarming calls" can be noticed almost immediately. After feeding, the baby often spews unchanged milk. You can also notice a strong secretion of mucus from the nasal passages, as well as abundant salivation.

In the event that the child has a moderate form of congenital stenosis, problems begin with the introduction of first food or solid food into the diet.

Acquired pathology develops gradually. As a rule, patients have difficulty with swallowing. For example, it may be painful when passing food through the esophagus, as well as the appearance of pain behind the sternum. At the initial stages, dysphagia is observed with the use of 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 not able to swallow water or even saliva.

If the stenosis is located in the cervical region, but soaking up 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 begin to accumulate in the area of constriction, which leads to frequent nausea and vomiting, the appearance of severe soreness. To dangerous consequences of stenosis can be attributed spontaneous ruptures of the esophagus wall.

Modern diagnostic methods

Even after talking with the patient, the doctor can express suspicions about the presence of stenosis. Of course, further research is needed. First of all, you need to conduct 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 method of diagnosis is radiography with the use of contrast medium (as a rule, barium salts are used). This procedure helps to study the relief and contours of the esophagus, as well as to study its peristalsis.

What methods of treatment does modern medicine offer?

The scheme of therapy depends on many factors, including the form of pathology, the stage of its development, the state of the patient, as well as 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 it is a question of pronounced dysphagia of the fourth degree, when the patient is not able even to take a sip of water, the food is administered intravenously.

There are several methods to eliminate constriction. In more light cases, balloon dilatation is carried out using bougie. But if the stenosis does not lend itself to similar methods of expansion, an endoscopic dissection of the strictures is performed. In the event that there is compression of the esophagus (for example, narrowing it near the growing tumor), a special stent can be inserted inside the lumen, which will retain the necessary dimensions of the esophagus.

Sometimes it happens that the above methods do not give the desired result, the stenosis continues to progress. The doctor can decide on a more radical decision - removing the affected part of the esophagus and then recovering it.

Is treatment possible with folk methods?

Traditional medicine is an industry that offers a huge number of alternative therapies. Is it possible to get rid of them from a disease such as esophageal stenosis? Treatment with 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 categorically contraindicated.

Are there effective preventive measures?

Unfortunately, really effective preventive means does not exist. As for congenital forms, it is important for the mother to monitor the state of health. In the presence of risk factors (a pregnancy transmitted 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 advised to follow the diet, as well as to treat the diseases of the digestive tract in time, not allowing their transition into a heavier or more chronic form.

Prognosis for patients with esophageal stenosis

In the absence of timely treatment, esophageal stenosis can lead to a mass 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 rarely recorded.