XVI. Diseases of the Esophagus.
Definition:—An acute inflammation of the esophagus, involving either the mucous membrane alone or the submucous structures, or both.
Etiology:—This disease seldom occurs from the ordinary causes of other inflammations, such as exposure to cold or suppression of secretions. It is caused by burns, by irritating substances, and from the accidental or other administration of caustics, such as concentrated lye and strong acids. Direct traumatism as a cause is very rare, although the swallowing of a fragment of oyster shell or a spiculum of bone, or sharp fish bones, or hard, angular substances, have in rare cases induced it.
The disease may occur in conjunction with other mouth or throat disease, as in the extension of thrush, or pharyngitis, or some cases of aphthous stomatitis. It will occur in a specific form from diphtheria, or it will follow scarlet fever, measles and smallpox. It occurs also as a sequel to typhoid and typhus fevers, and occasionally follows pneumonitis. Malignant disease of the esophagus is not uncommon.
Symptomatology:—The disease seldom develops with a marked chill, but there is general indisposition, a mild fever, with soft, quick pulse and considerable prostration. The mucous lining of the esophagus is red and swollen, there is a sensation of smarting or burning, with pain under the breast bone. Swallowing requires much muscular effort, is more or less painful, and may ultimately become impossible. Irritation resulting in spasm of the esophagus may cause the food to be regurgitated whenever an effort at swallowing is made. There may be a discharge of thick mucus or of mucus and pus, and in cases where caustics or active irritants have been taken, hemorrhage may occur. This may be a quite constant, mild discharge of blood, or there may be an occasional severe hemorrhage. There may be ulceration, in which case there is apt to be subsequent constriction or stenosis. Where there is a membranous exudate, it is apt to be an extension from the larynx or trachea, often of diphtheritic origin, and there will be difficulty of breathing as well as of swallowing.
Diagnosis:—Pain on the ingestion of food or upon any effort at swallowing is the first suggestion. The sensation of burning and extreme tenderness with the presence of a bloody mucus or muco-pus, with a tendency to a rapid increase of all the symptoms in acute cases, will confirm the diagnosis.
Prognosis:—In mild cases and in cases where there has been no great injury to the structure of the tube the prognosis is favorable, but where the cause has been severe, or where there has been much local irritation or severe injury to the structures of the esophagus, as when strong caustics have been taken, or where there is extension of mouth or throat disease, resulting in deep ulceration or the formation of pus, the prognosis must be guarded, as stricture may occur, with even permanent occlusion and death.
Treatment:—For the constitutional symptoms the use of small doses of aconite or aconite and arnica, in the proportion of from five to ten drops of each in a four-ounce mixture, a teaspoonful every hour, will be of service. Small doses of hamamelis and collinsonia, about five drops of each every hour, will exercise a beneficial influence. Where there is much destruction of tissue, the use of echinacea or echinacea and baptisia, in an infusion of marshmallows, to which a little boric acid has been added, should be given. The patient should have small quantities of crushed ice, and may be fed with ice-cream or iced milk, in small quantities, repeated at intervals of perhaps ten or fifteen minutes, when the sensation of burning is extreme, for perhaps two hours at a time. The food should be given in a bland and unirritating form, and in severe cases of the disease only liquids should be given by the mouth. In some cases this should be avoided and all foods should be given per rectum.