Oesophageal Tuberculosis: A Systematic Review Focusing on Clinical Management

• Published in: Dysphagia Vol. 37; no. 4; pp. 973 - 987
• Main Authors: Birda, Chhagan Lal, Kumar, Antriksh, Gupta, Pankaj, Singh, Harjeet, Sharma, Vishal
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.08.2022; Springer; Springer Nature B.V
• Subjects: Antitubercular agents; Bacilli; Compression; Computed tomography; Dysphagia; Endoscopy; Esophagus; Evidence-based medicine; Gastroenterology; Granuloma; Hepatology; Imaging; Lymph nodes; Lymphadenopathy; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Original Article; Otorhinolaryngology; Patients; Pseudotumors; Radiology; Systematic review; Tuberculosis; Ulcers; Canada; India; Deglutition; Tuberculosis; Oesophagus; Extrapulmonary tuberculosis; Dysphagia; Gastrointestinal tuberculosis; Deglutition disorders
• ISSN: 0179-051X; 1432-0460
• DOI: 10.1007/s00455-021-10360-x

Oesophageal tuberculosis, an uncommon form of extrapulmonary tuberculosis, has been reported mainly as small case series and the literature is heterogeneous. A systematic review to characterize the clinical presentation, evaluation and management of oesophageal tuberculosis was performed. Electronic databases were searched with keywords: esophagus OR esophageal AND tuberculosis. We included original papers and case series (> 4 patients) with oesophageal tuberculosis. Twenty-two studies reporting 311 patients were included. Mean age in most of the studies was 31–51 years and male gender constituted 50.5% patients. Dysphagia (72.3%), odynophagia (22.4%) and chest pain (31.3%) were predominant symptoms. Mid-oesophagus was the commonest site of involvement (88%). Endoscopic findings included ulcers (59.9%), submucosal bulge (31.7%), extrinsic compression (24.8%) and pseudotumour (5.8%). On endoscopic ultrasound, presence of hypoechoic (69.5%), heteroechoic (47.6%) and matted (86.3%) mediastinal lymph nodes and oesophageal wall involvement (67.3%) were common findings. Computed tomography showed mediastinal lymphadenopathy (76.5%) and oesophageal thickening (52.1%). Diagnosis was confirmed by granuloma (72.3%) and acid fast bacilli positivity (32.5%) in mots patients. Response to antitubercular therapy was excellent; 97.7% patients recovered and 2.3% patients died. Surgery (14.5%) and oesophageal stenting (11.4%) were required infrequently. Oesophageal tuberculosis should be considered in endemic regions as a cause of dysphagia because early treatment is associated with excellent outcomes.