X-ray picture of eosinophilic esophagitis

Posted by Master, Doctor Mai Vien Phuong - Gastrointestinal Endoscopy - Department of Medical Examination & Internal Medicine - Vinmec Central Park International Hospital

Eosinophilic esophagitis is an inflammatory condition in which the wall of the esophagus is infiltrated with large numbers of eosinophils, first recognized in 1978. Accordingly. The purpose of X-ray is to investigate for pathological problems in the esophagus for timely examination and treatment.

The esophagus is a muscular tube that helps the body push and swallow food from the mouth into the stomach. There are many causes of esophagitis, but the most common cause is acid reflux, which leads to a burning sensation in the throat, although acid reflux can cause ulcers on the inner lining of the esophagus.
Other, rarer causes are viruses (herpes simplex), fungi (candidiasis), drugs (tetracycline), radiation (lung cancer treatment). Physicians believe that eosinophilic esophagitis (VTQDBCAT) is a type of esophagitis caused by asthma-like allergies, or fever, allergic rhinitis, and even atopic dermatitis. some other allergens.

Eosinophilic esophagitis (VTQDBCAT) is an inflammatory condition in which the wall of the esophagus is infiltrated with large amounts of eosinophils, first recognized in 1978.
Accordingly, the endoscopic image of Eosinophilic esophagitis is quite diverse, including white patches, concentric rings, narrowing, mucosal loss of capillary network, paper thin esophagus, Schatzki ring, pseudo-diverticulum, and on endoscopic ultrasonography. The esophageal wall can be seen thick. Endoscopy helps to evaluate disease activity by identifying inflammation (signs of edema, exudation, longitudinal groove of the esophagus) and narrowing (esophageal ring, stricture) from which to decide on treatment. Interventional dilation of the esophagus when indicated as well as monitoring in response to treatment. However, the endoscopic method also has some limitations such as sensitivity and specificity of endoscopic images that vary based on the severity and number of lesions recorded, besides that in 10-25% of patients. normal endoscopic image.

On conventional radiographs, the gastrointestinal tract is not shown well. However, if you drink a white liquid that contains a chemical called Barium sulphate (BaSO4), the image of the upper gastrointestinal tract (esophagus, stomach, and small intestine) will be clearly shown on the image. X-ray image. The reason is because X-rays do not pass through Barium.
Depending on the location of the gastrointestinal tract to be examined, you may need one or more of the surveys listed below. Barium when ingested will form a layer that adheres to the lining of the digestive tract. Thus, abnormalities in the lining or structure of the gastrointestinal tract can be observed on radiographs.
In each of the following studies, radiographs were taken with a low dose of X-rays. The total radiation dose for each survey is quite small and is considered safe. The X-ray machine is connected to a TV monitor. A continuous snapshot or video X-ray may be considered if the doctor deems it necessary.

In this survey, you drink a liquid containing Baryt. The liquid usually has a fruity flavor that makes it pleasant to drink. You stand in front of an X-ray machine and X-rays will be taken while you swallow this liquid. The purpose of the survey is to look for problems in the esophagus such as: esophageal stricture, diaphragmatic hernia, tumors, gastroesophageal reflux, swallowing disorders, etc. Usually you will be asked not to eat. drink a few hours before taking this survey. A contrast-enhanced esophagogram with Baryt takes about 10 minutes.
4.1. X-ray image of normal oesophagus Normal esophagus has a clear border, mucosal folds running parallel to each other, divided into three segments:
Short neck segment. The longest thoracic segment, located close to the posterior border of the heart, has two imprints of the aorta and the left main bronchus. The abdomen is very short, after passing through the diaphragmatic foramen and ending with the cardia, it pours into the posterior surface - in the large gastric aneurysm and creates with this part an acute angle that is the angle of His, which has the function of preventing gastric reflux. - esophagus.

4.2. What is the contrast-enhanced esophageal radiograph of eosinophilic esophagitis? Among imaging methods, barium esophageal scintigraphy is the most commonly used technique, especially when patients present with symptoms of dysphagia or choking. A common image on Baryt's scan of eosinophilic esophagitis is esophageal rings or strictures, however, when compared with endoscopy, this technique cannot evaluate mucosal lesions.

For esophageal stricture, according to a study performed on patients with eosinophilic esophagitis, the rate of stenosis detected by Baryt angiography was up to 71%, of which stenosis was mainly in the lower esophagus. Another study noted that the stricture was mainly located above or in the thoracic esophagus.

The diameter of the stenosis averages about 1 cm, and the stenosis in the upper/middle esophagus tends to be longer than in the lower part. Depending on the location of the narrow segment on Baryt scan, other differential diagnoses should be considered. Other causes of narrowing of the upper or middle esophagus include Barrett's esophagus, mediastinal radiation therapy, and the use of certain drugs such as NSAIDs, quinidine, while narrowing in the lower esophagus can be caused by esophagitis. Reflux. It should be noted that patients with esophageal stricture on Barytography often have symptoms of dysphagia and this is only a suggestive sign, it is necessary to combine many factors related to history, clinical symptoms, and imaging endoscopy and histopathology. Esophageal ring is also a common image with many terms being used such as “esophagogastric tracheostomy” or “ringed esophagus”. The location and distribution of the rings of the esophagus vary widely on endoscopy, either in segments of the esophagus or diffusely distributed. Sometimes these loops can cause a narrowing that makes it difficult for the rope to pass through. On Barytography, these rings are often numerous, often appear close together, concentrically along the lumen of the esophagus.

In recent years, there have been a number of additional studies applying computed tomography or endoscopic ultrasound in the evaluation of VTQDBCAT. On computed tomography imaging, thickening of the esophageal wall can be seen. Some images on endoscopic ultrasound include normal layers of the esophageal wall or diffuse thickening of the esophageal wall due to inflammation and transmural fibrosis or focal thickening of the muscular or submucosa
Although Eosinophilic esophagitis has some characteristic features, however, it should be differentiated from the narrow inflammatory images of Barrett's esophagus, mediastinal radiotherapy, and the use of certain drugs such as NSAIDs, quinidine , and requires endoscopy, biopsy for histopathology to confirm the diagnosis.