Esophageal tuberculosis associated with esophagotracheal or esophagomediastinal fistula: report of 10 cases

Abstract

Esophageal tuberculosis is rare but appears to be increasing, especially in endemic areas and in immunosuppressed individuals. The esophagus is involved by spread from adjacent structures. The natural history, complications, and treatment of this condition are unclear. Experience with 10 cases of esophageal tuberculosis encountered from 1995 to 2000 is described. Esophageal tuberculosis was always associated with spread from adjacent structures such as mediastinal or cervical lymph nodes and the spine. Dysphagia or coughing on eating were the predominant symptoms. Esophageal ulcers with undermined edges were the most common finding, followed by esophageal sinuses or fistulous openings. One patient died of disseminated disease; the remaining 9, including 4 with esophagotracheal or esophagomediastinal fistulas, recovered by treatment with antituberculous drugs alone. Esophageal tuberculosis almost always is associated with mediastinal lymphadenopathy. In half of the cases, it is associated with an esophagotracheal fistula or an esophagomediastinal sinus. Despite these complications, patients can be treated safely with antituberculous drugs alone.