Overview.
Septic inflammation caused by the invasion of purulent bacteria into the esophageal mucosa when there is a breach in the esophageal mucosa. It is most often secondary to injury to the esophageal mucosa caused by a foreign body or instrumentation of the esophagus. Septic esophagitis can be a limited lesion, and most often forms one or more submucosal abscesses that drain into the esophageal lumen and resolve spontaneously. The infection may also spread and cause esophageal cellulitis, involving the peri-esophageal tissues and the mediastinum or adjacent thoracic cavity to form a fistula.
Etiology
The pathogens of the infection are mostly gram-positive cocci and gram-negative bacilli of the pharynx. Infections due to esophageal injuries associated with Nocardia have been reported generally occurring at or near the site of the injury. Infections in immunocompromised individuals are more common in the middle and lower esophagus. The infection may be limited to one or several small abscesses or may be more extensive with cellulitis, involving the peri-esophageal tissues, mediastinum, or adjacent organs to form a fistula.
Symptoms
depend largely on the extent of the infection and the responsiveness of the patient. In more limited infections, the abscess may resolve spontaneously by penetrating and draining into the esophageal lumen, and the patient may be asymptomatic or have only neck pain or sore throat. Patients with more extensive lesions may present with dysphagia, retrosternal pain, chills, and fever in addition to neck pain or sore throat. Higher reactivity often results in high fever. A few patients may develop sepsis with corresponding manifestations.
Examination
1. Blood routine
The total number of leukocytes and neutrophils are elevated.
2. Bacterial culture of esophageal secretion for pathogenic bacteria.
3. Endoscopy
Congestion, edema, ulceration, pseudomembrane and increased local fragility of esophageal mucosa are common.
4. Endoscopic biopsy pathology
If more bacteria are seen in the submucosa, the diagnosis can be established.
Diagnosis
1. History of injury caused by esophageal foreign body or instrumental examination.
2. Clinical manifestations such as fever and retrosternal pain.
3. Endoscopic finding of abscess and other lesions.
Differential diagnosis
Septic esophagitis often occurs in a state of generalized immunocompromise, and may be combined with other pathogens such as viral and fungal infections.
Complications
The infection may also spread to cause esophageal cellulitis, involving peri-esophageal tissues such as the mediastinum and adjacent organs to form fistulas.
Treatment
1. Rational use of antibiotics to control infection
Penicillins and cephalosporins work well, and antibiotics for gram-positive bacteria are usually chosen, and effective antibiotics can be chosen according to drug sensitivity test when available. Clinical use of intravenous drug mainly.
2. Symptomatic treatment
Including proton pump inhibitors to inhibit gastric acid, help the healing of esophageal lesions, such as omeprazole, pantoprazole, rabeprazole, lansoprazole, esomeprazole, etc., mainly administered intravenously.
3. Drainage of abscess through gastroscopy
Gastroscopy is used to partially drain the abscess by suctioning the pus from the abscess site with a hypodermic needle.
4. Surgical treatment
If the lesion involves the surrounding tissues, forms a fistula with the mediastinum and the adjacent organs, and is not effective in conservative medical treatment, surgical fistula repair or esophagectomy can be performed.
Prevention
Prevent foreign body, mechanical injury to the esophageal mucosa damage caused by pathogenic bacteria invasion of the esophageal wall, the formation of inflammation.