Mycobacterial infections are most common in esophageal inflammation, mainly Candida albicans, other mycobacteria can occasionally be cultured, and they are sometimes combined with Candida albicans to cause disease. Etiology Mycobacteria can be present in normal people, 35%-50% of normal people and 70% of hospitalized patients can be cultured in the oropharynx Candida albicans. In some environments, mold can become pathogenic, and the degree of infection is determined by the pathogenicity of the mold and the body’s defenses. Certain conditions promote mycobacterial overgrowth, increasing the risk of infection, such as the long-term application of high doses of antibiotics, taking drugs that inhibit gastric acid secretion, hyperglycemia are prompted to multiply mycobacteria. When the esophageal mucosa suffered damage or acid stimulation, radiation therapy, chemotherapy and other cases, the mucosal barrier can be destroyed, easy to mycobacterial infection. When the body’s immune function is impaired, such as high-dose hormone therapy, malignant tumors, some endocrine dysfunction, adrenocortical insufficiency, diabetes, pregnancy, renal insufficiency, etc., all increase the sensitivity of the esophagus to mycobacterial infections. There are 3 forms of esophageal mycobacterial infection: 1. acute infection: extremely debilitated immunosuppressed patients often die from acute mycobacterial infection; 2. subacute infection: esophageal stricture or pseudodiverticulum formation; 3. chronic infection: usually starts in childhood, mostly combined with submucosal mycobacterial infection and immunocompromised. Clinical manifestations The main manifestations are painful swallowing, swallowing due to difficulty and retrosternal pain. The presence and severity of pain is highly variable and its severity can be related to the urgency of the attack and the extent of inflammation. Other symptoms include food reflux, nausea, vomiting and food aversion. In some cases, sudden or persistent hyperthermia, elevated leukocytes, occasional upper gastrointestinal bleeding, and lack of esophagitis symptoms during the treatment of the primary disease should alert the occurrence of acute mycobacterial esophagitis. Diagnosis 1. characteristic clinical manifestations: painful swallowing, dysphagia and retrosternal pain; 2. upper gastrointestinal lock meal imaging: typical early manifestation of abnormal imaging is the disappearance of normal mucosal texture, replaced by nodular or cobblestone-like or even serrated filling defects, occasionally becoming giant filling defects when combined with inflammatory edema, resembling signs of esophageal cancer, sometimes multiple pseudodiverticula can be seen, and long-term chronic inflammation can form Endoscopic examination: the mucosa of the esophagus is diffusely congested, brittle, eroded, ulcerated and pseudomembranous, with extensive necrosis, and occasionally mycobacterial masses or granulomas, typically showing patches of mucosal epithelium covered with pseudomembranous plaques of milky white or green mucous secretions, with erythematous brittle mucosa underneath and surface mucosal ulcers. The diagnosis requires endoscopic brush cytology or histopathological biopsy. Treatment and prognosis Mycobacterial esophagitis is mainly treated with medication. Currently, the more clinically used anti-mycobacterial drugs are mycobacterium, amphotericin B and flucytosine, and others are clotrimazole, clenbuterol, imipramine and trimethoprim. The efficacy is determined by the severity of the mycobacterial infection and the degree of immunosuppression of the body. In general, regular antimycobacterial treatment can yield good results, but the application of high-dose antibiotics to treat the primary infection along with secondary mycobacterial infections is not effective. If the mycobacterial infection causes severe esophageal stricture, surgical management needs to be carefully considered.