Tuberculosis of the Digestive System

Esophageal tuberculosis is one of the rare localizations of this disease and in most cases is observed in persons with advanced pulmonary forms shortly before death.

Etiology, pathogenesis. Mycobacterium tuberculosis enters the esophagus when swallowing infected sputum, with active tuberculosis of the larynx, epiglottis and pharynx, less often by lympho- or hematogenous route, as well as as a result of direct transfer of the tuberculosis process from surrounding organs: bifurcation lymph nodes, spine, thyroid gland, larynx, pharynx .

Tuberculous ulcers arise as a result of caseous decay of tuberculous tubercles. There are also miliary and stenotic forms of tuberculous lesions of the esophagus.

Symptoms, course. The disease can be asymptomatic, but more often its symptoms are obscured by more pronounced manifestations of tuberculous damage to other organs (primarily the lungs and larynx) and the severe general condition of the patient. The most striking symptom is dysphagia, which, in the presence of ulcerations of the mucous membrane, can be accompanied by severe pain. X-ray examination reveals large tuberculous ulcers and cicatricial narrowing of the lumen of the esophagus.

The diagnosis is facilitated by esophagoscopy, biopsy, and bacteriological examination of material obtained from the ulcer. Treatment is carried out in specialized anti-tuberculosis hospitals. For tuberculous ulcers of the esophagus, bismuth preparations and local anesthetics are additionally prescribed orally.

In case of cicatricial narrowing of the esophagus, bougienage is performed; in some cases, a gastrostomy tube is temporarily placed to maintain the patient’s nutrition.

The prognosis is determined by the severity of tuberculous changes in the lungs and other organs.

Complications: fistulous communications of the esophagus with the trachea, bronchi, pleura, purulent mediastinitis; breakthrough of the caseous cavity into a large vessel threatens with profuse bleeding. During the healing of tuberculous ulcers, strictures of the esophagus are formed, its patency is disrupted: as a result of the adhesive process between the bifurcation lymph nodes and the wall of the esophagus, traction diverticula are formed.

Gastric tuberculosis is very rare, usually in the terminal phase of pulmonary tuberculosis. Recently, however, “medicinal gastritis” has been discovered in patients with pulmonary tuberculosis as a result of long-term treatment with anti-tuberculosis drugs.

The disease may be asymptomatic or accompanied by pain in the epigastric region, belching, vomiting, and a sharp decrease in appetite; as a rule, general exhaustion, fever, and increased sweating are observed.

The diagnosis of gastric tuberculosis is confirmed by X-ray examination and gastrofibroscopy. Therefore, targeted biopsy is of particular value. When examining gastric juice, achylia is often detected; mycobacterium tuberculosis is found in gastric contents (usually in washing waters).

The course and prognosis in most cases are determined by the severity of pulmonary and other localizations of tuberculosis. Rare complications include perforation of a tuberculous gastric ulcer, gastric bleeding, and cicatricial pyloric stenosis.

Treatment is carried out in specialized tuberculosis hospitals. Patients with tuberculous lesions of the stomach are prescribed a gentle diet (table No. 1a-1) and symptomatic medications (as in the treatment of gastric and duodenal ulcers).

Pancreatic tuberculosis is very rare. Even in patients with active pulmonary tuberculosis, it is detected only in 0.5-2% of cases.

Patients complain of belching, loss of appetite, nausea, pain in the upper left quadrant of the abdomen, often of a girdle nature, diarrhea, increased thirst (if