Chronic esophagitis is caused by occlusion of the trophoblastic vessels due to syphilitic periarteritis, which leads to necrosis of the esophageal mucosa, mucosal erosion, scar formation and secondary infection. As syphilis infection involves the larger trophoblastic vessels of the esophagus, vascular occlusion may result in deep ulcers in the associated esophageal areas. Syphilis can cause extensive fibrous tissue proliferation in the submucosa of the esophagus, resulting in narrowing of the esophageal lumen. In a small number of patients, a dendritic swelling may develop in the esophagus, with clinical symptoms resembling esophageal tumors. Esophageal dysfunction can occur at any stage of the syphilitic process; in a few patients, dilatation of the lower esophagus occurs as a result of inflammatory infiltration into the interosseous plexus of the esophagus. The two main complications of syphilitic esophageal lesions are spontaneous perforation of the esophagus and esophageal obstruction. Esophageal perforation or erosion is due to periarteritis of the esophageal wall caused by syphilis, resulting in occlusion of the trophoblastic vessels, whereas esophageal obstruction is due to fibrotic stricture of the esophagus. The key to the diagnosis of this disease is to be highly alert to syphilis patients with esophageal symptoms and to apply endoscopy optionally to look for esophagitis, esophageal ulcers, esophageal strictures or proliferative lesions, which generally occur in the middle segment of the esophagus. The diagnosis should be mainly differentiated from esophageal cancer. The treatment of this disease should be mainly according to the treatment principle of stage III syphilis, but it should be noted that in the process of anti-syphilis treatment, the formation of scar tissue may aggravate the symptoms of esophageal obstruction, at this time, it is appropriate to perform esophageal dilatation treatment.