Stenosis of the Esophagus.
Definition.—A diminution of the caliber of the esophagus by cicatricial contraction, thickening of its walls, or by pressure from growths.
Etiology.—The most common cause is due to an injury of the mucous membrane by corrosive fluids, resulting in cicatricial contraction. A chronic inflammation of the tissues of the tube may result in thickening of the same, thus lessening its caliber. Cancerous infiltration in the walls of the esophagus is not an uncommon cause. More rarely contraction from tubercular, syphilitic, or variolous ulcerations takes place. Pressure from without by growths, either malignant or benign, is an occasional cause. A wound of the esophagus may also cause stenosis by contraction during the repair of the injury.
Pathology.—The stricture may involve any portion of the tube, and may be very slight, or so severe that fluids pass with difficulty. It may be confined to a part, or involve the entire organ. If the lower third be affected there will be dilatation of the upper portion, with hypertrophy of the walls.
Symptoms.—These depend largely upon the degree of obstruction, the location of the stricture, and the causes producing it. Difficulty in swallowing, more or less, is a distressing feature in all cases; though, at first, but slight, and when some substance larger than usual is swallowed. A sense of constriction and a dull, tensive pain are experienced. As the stenosis increases, the dysphagia becomes more marked. If the stricture be located in the lower part, more or less food accumulates in the dilated upper portion, to be ejected three or four hours later. This is alkaline in reaction and contains mucus and sometimes pus and blood. If there be ulceration, pain is experienced on taking food. The general health suffers in proportion to the degree of the stricture and impairment of the nutrient material. If the stricture be due to cancer, the continued dull pain, with occasional darting pains, the distressing dysphagia on taking food or drink, the presence of blood in the ejected food, and, above all, the gradual emaciation, the yellow, waxy, sodden cachexia, will be characteristic.
Diagnosis.—This is readily made by the symptoms already described, though, to be positive, the esophageal sound should be used, when we readily determine the location and degree of the stricture.
Prognosis.—It is unfavorable in the large majority of cases. Where, there is but little structural change, repeated dilatation will effect a cure.
Treatment.—It is very doubtful if medicines produce any influence on this unfortunate condition. The treatment, therefore, will be entirely mechanical. The frequent and careful dilatation, with graduated sounds, will effect a cure where the stricture is confined to the mucous or submucous tissues. Where there is cancerous infiltration, the sound should be avoided as it only sets up irritation, causes pain, and generally aggravates the disease. Galvanism, in the hands of one thoroughly capable of using it, promises much, though the uninstructed had better not attempt its use. Spasmodic stricture occurs in females between the ages of eighteen and thirty, and who are hysterically inclined. The treatment in such cases will be symptomatic, antispasmodics being most frequently indicated. Should it be reflex, the exciting cause should be sought till found and removed, when the spasm will cease.