Читать книгу The Esophagus - Группа авторов - Страница 180

Alkaline reflux esophagitis is caused by reflux of bile or pancreatic secretions into the esophagus after partial or total gastrectomy [114]. The esophagitis is characterized on barium studies by mucosal nodularity or ulceration, or, in severe disease, by the development of distal esophageal strictures that may progress rapidly in length and severity over a short period of time [114]. The risk of developing alkaline reflux esophagitis can be decreased by performing a Roux‐en‐Y type of reconstruction to prevent or minimize reflux of bile or pancreatic secretions into the esophagus after partial or total gastrectomy.

Figure 6.45 Candida esophagitis with plaques. Double‐contrast view shows multiple discrete plaque‐like lesions in the esophagus. Note how the plaques have a linear configuration and are separated by segments of normal intervening mucosa. This appearance is characteristic of Candida esophagitis.

Source: Reproduced from Levine et al. [88], with permission.

Nasogastric intubation is an uncommon cause of esophagitis and stricture formation in the distal esophagus [112]. Most strictures develop after prolonged nasogastric intubation, but some patients have developed strictures from nasogastric tubes that were in place for as little as 48 h [112]. It has been postulated that these strictures result from severe reflux esophagitis caused by constant reflux of acid around the tube into the distal esophagus. Such strictures may progress rapidly in length and severity on follow‐up barium studies [112].

Other uncommon causes of esophagitis include Crohn’s disease, acute alcohol‐induced esophagitis, chronic graft‐versus‐host disease, Behçet’s disease, and, rarely, skin disorders involving the esophagus, such as epidermolysis bullosa dystrophica and benign mucous membrane pemphigoid [112].

Figure 6.46 Advanced Candida esophagitis with “shaggy” esophagus. Double‐contrast view shows a grossly irregular or shaggy esophagus caused by innumerable coalescent plaques and pseudomembranes with trapping of barium between the lesions. Also note a superimposed ulcer (arrow) due to sloughing of diseased mucosa. This patient had acquired immunodeficiency syndrome.

Source: Reproduced from Levine et al. [90], with permission.