Diagnosis, to be certain, requires the demonstration of the tubercule bacilli and the characteristic cell accumulation of the tubercle in a specimen of tissue removed from the lesion. Actinomycosis must be excluded, and the possibility of mixed luetic and tuberculous lesions is to be kept in mind. Post-tuberculous cicatrices have no recognizable characteristics.
Treatment.—The maintenance of nutrition to the highest degree, and the institution of a strict antituberculous regime are demanded. Local applications are of no avail. Gastrostomy for feeding should be done if dysphagia be severe, and has the advantage of putting the esophagus at rest. The passage of a stomach-tube for feeding purposes may be done, but it is often painful, and is dangerous in the presence of ulceration. Pain is not marked if the lesion be limited to the esophagus, though if it is present orthoform, anesthesin, or apothesin, in powder form, swallowed dry, may prove helpful.
VARIX AND ANGIOMA OF THE ESOPHAGUS
These lesions are sometimes the cause of esophageal hemorrhage, the regurgitated blood being bright red, and alkaline in reaction, in contradistinction to the acid "coffee ground" blood of gastric origin. Esophageal varices may coexist with the common dilatation of the venous system in which the veins of the rectum, scrotum, and legs are most conspicuously affected. Cirrhosis and cancer of the liver may, by interference with the portal circulation, produce dilatation of the veins in the lower third of the esophagus. Angioma of the esophagus is amenable to radium treatment.
ACTINOMYCOSIS OF THE ESOPHAGUS
Esophageal actinomycosis has been autoptically discovered. Its diagnosis, and differentiation from tuberculosis, would probably rest upon the microscopic study of tissue removed esophagoscopically, though as yet no such case has been reported.
ANGIONEUROTIC EDEMA
Angioneurotic edema involving the esophagus, may produce intermittent and transient dysphagia. The lesions are rarely limited to the esophagus alone; they may occur in any portion of the gastrointestinal, genitourinary, or respiratory tracts, and concomitant cutaneous manifestations usually render the diagnosis clear. The treatment is general.
DEVIATION OF THE ESOPHAGUS
Deviation of the esophagus may be marked in the presence of a deformed vertebral column, though dysphagia is a very uncommon symptom. The lack of esophageal symptoms in deviation of spinal production is probably explained by the longitudinal shortening of the spine which accompanies the deflection. Compression stenosis of the esophagus is commonly associated with deviations produced by a thoracic mass.