Diagnosis Of Esophageal Tuberculosis Research Articles

Role of Endoscopy in Esophageal Tuberculosis: A Narrative Review

Esophageal tuberculosis (ET) is a rare infectious disease of the gastrointestinal tract. Awareness of ET is deficient due to its low incidence. Unexplained dysphagia and upper gastrointestinal bleeding are the most common symptoms of ET. The prognosis is generally good if patients are diagnosed properly and receive anti-tubercular treatment promptly. However, ET is difficult to differentiate from other diseases. Endoscopic techniques such as esophagogastroduodenoscopy (EGD), endoscopic ultrasonography (EUS), contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS), elastography, and endoscopic ultrasound--guided fine-needle aspiration (EUS-FNA) improve the diagnosis of ET. Thus, the characteristics of ET and other difficult-to-detect diseases according to EGD and EUS were summarized. Intriguingly, there is no literature relevant to the application of CH-EUS and elastography in ET. The authors' research center was first in introducing CH-EUS and elastography into the field of ET. The specific manifestation of ET based on CH-EUS was discovered for the first time. Correlative experience and representative cases were shared. The role of endoscopy in acquiring esophageal specimens and treatment for ET was also established. In this review, we aim to introduce a promising technology for the diagnosis and treatment of ET.

Esophageal tuberculosis.

Esophageal tuberculosis (ET) is an extremely rare disease and herein, we present an ET case. Endoscopic findings of ET are variable and diverse and can be easily mistaken for malignancy. A definitive diagnosis of ET is difficult to make with white light endoscopy alone, and the diagnostic yield of a biopsy is low in secondary ET cases with normal overlying mucosa. Although the findings of conventional endoscopy and endoscopic ultrasonography in ET have been reported so far, few reports have described the findings of magnifying endoscopy with narrow-band imaging (ME-NBI). Dilated microvessels without irregularities on ME-NBI may be useful to differentiate secondary ET from esophageal carcinoma, since the findings suggest compression from the depth. Although rare, ET has to be considered in the differential diagnosis for any unexplained esophageal lesions.

Diagnosis and treatment of esophageal tuberculosis

Diagnosis and treatment of esophageal tuberculosis

Endosonography and elastography in the diagnosis of esophageal tuberculosis

Endosonography and elastography in the diagnosis of esophageal tuberculosis

Esophageal Tuberculosis: A Manifestation of TB Reactivation during Treatment of Hepatitis C

Purpose: Hepatitis C and tuberculosis often co-exist, especially among patients from regions in which TB is endemic. In spite of this association, TB reactivation is not commonly seen in patients being treated for HCV. We describe a patient who developed esophageal tuberculosis as the manifestation of TB reactivation during combination therapy for hepatitis C. A 42 year old HIV-negative Ethiopian female with genotype 4 hepatitis C at 15 weeks of treatment with Peg-IFN and ribavirin presents with worsening dysphagia and odynophagia for three weeks. She also noted a mild cough with swallowing, but no hemoptysis. Other than general malaise, subjective fevers and chills since starting HCV treatment, she had no other complaints. Physical exam and routine laboratory studies were unremarkable. Upper endoscopy showed two deep ulcers in the proximal and mid-esophagus. Biopsies revealed multiple non-necrotizing granulomas. Chest CT showed right apical and subcarinal heterogeneous masses. Lymph node cultures from EUS/FNA and respiratory samples both grew organisms resembling Mycobacterium tuberculosis, thus, the diagnosis of esophageal tuberculosis was made. Given the temporal relationship of HCV treatment and development of esophageal TB, the salient question is if there is a relationship between hepatitis C and tuberculosis. Multiple characteristics increased this patients' risk for developing active TB. Among African immigrants, over 50% are PPD positive and over 10% have signs of pulmonary TB. Additionally, HCV and TB often co-exist; patients with HCV are about 3 times as likely to also have latent TB. Furthermore, reactivation of TB during HCV treatment, while rare, has been described in at least 4 case reports and a series describing tuberculous lymphadenopathy. While the mechanism is unclear, clinical studies have found an increased risk of infection with HCV treatment, independent from drug-induced neutropenia, and particularly associated with Peg-IFN. This may represent the impairment of macrophage phagocytosis from the accumulation of polyethylene glycol in patients treated with Peg-IFN. Additionally, in vitro models have shown that treatment of human monocytes and macrophages with IFN results in unrestrained mycobacterial growth. To our knowledge, this is the first case of esophageal tuberculosis occurring as a result of hepatitis C treatment. As we treat more immigrants from areas where TB is endemic, TB reactivation may become more common. This potential complication highlights the need for heightened awareness, and consideration of screening, in high risk patients undergoing HCV treatment.

Dysphagia as a manifestation of esophageal tuberculosis: a report of two cases

IntroductionEsophageal involvement by Mycobacterium tuberculosis is rare and the diagnosis is frequently made by means of an esophageal biopsy during the evaluation of dysphagia. There are few cases reported in the literature.Case presentationWe present two cases of esophageal tuberculosis in 85- and 65-year-old male Caucasian patients with initial complaints of dysphagia and epigastric pain. Upper gastrointestinal endoscopy resulted in the diagnosis of esophageal tuberculosis following the biopsy of lesions of irregular mucosa in one case and a sessile polyp in the other. Pulmonary tuberculosis was detected in one patient. In one patient esophageal stricture developed as a complication. Antituberculous therapy was curative in both patients.ConclusionAlthough rare, esophageal tuberculosis has to be kept in mind in the differential diagnosis of dysphagia. Pulmonary involvement has important implications for contact screening.

Value of Endoscopic Ultrasonography for Diagnosis of Esophageal Tuberculosis: Report of Two Cases

Esophageal tuberculosis (ET) is rare, even in countries with a high incidence of tuberculosis (1). In some cases, differential diagnosis of ET from esophageal carcinoma is very difficult and may result in an unnecessary esophagectomy (2). One of the main reasons for this difficulty is the poorly described clinical, radiological, and endoscopic features of ET because of its rarity. Another reason is that the evidence of this infection such as isolation of tubercle bacilli and caseous necrosis is not usually detected (3). There are insufficient data on the utility of endoscopic ultrasonography (EUS) in the diagnosis of ET. Herein, we present EUS findings of two cases with ET that were treated successfully with antituberculous chemotherapy.

Esophageal Tuberculosis

To study the utility of endoscopic cytology in the diagnosis of esophageal tuberculosis in clinically unsuspected cases. During a period of four years, endoscopic cytology of esophageal lesions was performed on 228 patients. In eight (3.5%) the cytologic diagnosis of esophageal tuberculosis was suggested on smears. Upon endoscopic examination, the sites of involvement were mid esophagus (five cases), upper esophagus (two cases) and lower esophagus (one case). Linear ulcer was seen in six cases; growth and narrowing of the lumen were seen in one case each. Endoscopic brush smears in seven cases and fine needle aspiration cytology smear in one case were collected. Air-dried smears stained by Giemsa stain were reviewed for detailed cytologic assessment. Smears showed well-defined granulomas with necrosis in five cases and granulomas without necrosis in three. Cytologic evidence of concurrent poorly differentiated squamous cell carcinoma was observed in one case. Tubercle bacilli were demonstrated in five cases. Endoscopic biopsy showed granulomas in three cases and tubercle bacilli in one case. In six cases there was no clinical or radiologic evidence of tuberculosis at other sites, thereby suggesting the possibility of primary esophageal tuberculosis. The remaining two cases had a past history of tuberculosis; one presented with cervical lymphadenopathy and one mediastinal lymphadenopathy. All patients received antitubercular treatment, and the patient with concurrent malignancy also received radiotherapy. All but one of the patients who succumbed to aspiration pneumonia responded to treatment. Endoscopic cytology is a useful modality in the diagnosis of esophageal tuberculosis in clinically unsuspected cases.