Esophageal tuberculosis: is it so rare? Report of 12 cases and review of the literature

Abstract

OBJECTIVE: Mycobacterial involvement of the esophagus is rare in both immunocompetent and immunocompromised hosts with advanced pulmonary tuberculosis, even in countries with high prevalence rates like India. Most of the reported cases of esophageal tuberculosis (ET) are secondary to tuberculosis elsewhere in the body, most commonly pulmonary tuberculosis. Very few cases of isolated or primary ET have been reported, and most of them have been from developing countries. The upsurge in reported cases of tuberculosis linked to the AIDS epidemic has increased the incidence of this infection in developed countries also. Our aim is to study tuberculosis as an etiological factor in the causation of dysphagia, the role of cytology and histopathology in establishing its diagnosis, and the outcome of antitubercular treatment in these patients. METHODS: A hospital-based, retrospective study was performed. We reviewed records of all of the patients who underwent upper GI endoscopic examination for complaints of persistent dysphagia (>6 wk) in a tertiary care hospital in India between 1995 and 1999. Patients with abnormal endoscopic findings were subjected to endoscopic fine needle aspiration/brush cytology and biopsies. Those with pathological findings suggestive of tuberculosis were treated with antitubercular therapy. RESULTS: Tubercular involvement of the esophagus, confirmed by pathological examination, was found in 12 patients. They constituted 0.5% of all patients with persistent dysphagia, and 1.3% of all patients having abnormal esophagoscopic findings. Cytological examination provided a very useful diagnostic parameter in detection of these cases. Patients diagnosed as having ET responded well to antitubercular therapy. CONCLUSIONS: Tuberculosis as a causative factor for dysphagia should be considered in developing countries with high incidences of tuberculosis and in immunocompromised hosts. Detection of these cases by careful examination of cytological smears and biopsies and treatment with standard antitubercular therapy appear effective.