The problem of the acquired short esophagus; report of 18 patients

Abstract

A shortened esophagus is probably acquired, rather than congenital, in the great majority of cases. The process by which the shortening develops, as described by Allison and his coworkers, begins with esophageal hiatal hernia, followed by esophagitis caused by the irritation of acids from the stomach, then recurrent ulceration and healing which forms scar tissue which little by little shortens the esophagus. Obesity and relaxation of the supporting musculotendinous structures which accompany advancing years probably are contributory factors in production of esophageal hiatal hernia. Fifteen of a series of 18 patients noted the onset of symptoms on or after the age of 45. Roentgen examination of the esophagus and stomach is indispensable in establishing a diagnosis of acquired short esophagus. Esophagoscopic examination is even more important. In some cases endoscopic differentiation between acute inflammation and carcinoma is difficult. In such circumstances examination of a biopsy specimen taken from the gastric mucosa immediately distal to the area of inflammation or stricture may be helpful. Results in eight patients with advanced esophageal shortening and stricture who were treated conservatively indicate that this should be tried before surgical treatment is considered. For patients with esophageal hiatal hernia accompanied by shortening of the esophagus that is just beginning to produce symptoms, early repair is indicated, since the condition is progressive and the surgical problem is much simpler in the early stages.