Esophageal Papillomatosis Symptoms, Causes, Diagnosis, Treatment

Esophageal papilloma, a rare benign tumor, is sometimes linked to HPV infection. This HPV infection can develop digestive tract carcinomas, upper respiratory tract carcinomas, anogenital cancers, and cervix cancer.

Squamous papillomas are aberrant masses that can develop in the esophagus. Squamous papillomas appear as tiny, whitish-pink exophytic projections that resemble warts. The majority of lesions are asymptomatic. Lesions less than 1 cm in diameter are often excised through endoscopy, while bigger lesions frequently require endoscopic mucosal excision. 

A variety of outcomes are possible with esophageal squamous cell papillomas, ranging from spontaneous remission to malignant transformation. The following cases require malignant transformation:

1. Virulent HPV strains
2. Dysphagia
3. Esophageal Stricture.  

Treatment is usually recommended for esophageal squamous papillomas since they have the potential to turn cancerous. Papillomas are harmless tumors. This means they do not disseminate around the body and do not proliferate aggressively. 

The cancerous tissues of esophageal papillomatosis grow in specific types of tissue. When papillomas reach the skin, they are commonly referred to as warts or verrucae. They are formed on the areas that are wet or moist.

Esophageal Papillomatosis Symptoms

The common symptoms of esophageal papillomatosis are chest pain and odynophagia. Odynophagia is a common presenting symptom of esophageal papillomatosis that induce esophageal mucosa breaches. 

Many papillomas are asymptomatic, causing just discomfort. Because of their look, they might induce anxiety and lower self-esteem in certain people. Only a small percentage of papillomas cause medical problems. 

The papillomas that are formed in the breast of the females show the symptoms of watery or bloody discharge from the nipple. A single leaky papilloma in the breast is unlikely to become malignant, and these papillomas can be removed with treatment.

The other symptoms of esophageal papillomatosis might include the following:

1. A weak or silent cry.
2. A blockage in the airways.
3. Hoarseness.
4. Difficulty in swallowing.

Esophageal Papillomatosis Causes

The most common cause of esophageal papillomatosis is human papillomavirus (HPV). Some of the causes of esophageal papillomatosis are as follows:

1. Aging.
2. Tobacco consumption.
3. Use of alcohol.
4. Chronic acid reflux and Barrett’s esophagus.
5. Chemical exposure at work.

Acute esophageal papillomatosis is a condition in which there are chances of developing cancerous tissues in certain parts of the body. These cancerous tissues can develop esophageal cancer which is associated with the disease achalasia. Due to achalasia, excess skin is formed on the hands and feet and the patient finds it difficult to swallow the food. So, this achalasia is considered a cause of esophageal papillomatosis. 

Esophageal Papillomatosis Diagnosis

The doctors can assess the disease through certain kinds of tests. After examining the patient physically the doctors recommend various types of tests that can help in diagnosing the disease. These tests are as follows:

1. Biopsy: In this test, the doctors examine the cells under the microscope by taking a sample of the tissues from the esophagus.                                   
2. Upper Endoscopy:  An EGD or upper endoscopy is utilized to diagnose esophageal squamous papillomas, during which a flexible camera is used to inspect the esophagus. These lesions are frequently discovered by chance during an EGD.
3. Computed Tomography (CT): Through this, doctors measure the severity of the disease.
4. Esophagoscopy: This test is used to look inside the esophagus through a lighted, thin tube which is called an endoscopy.
5. Barium Swallow: It is a technique through which doctors conduct a series of X-rays to view the esophagus.
6. Esophageal endoscopic ultrasound: It is a procedure through which doctors view the esophagus from the inside with the help of sound waves.

Esophageal Papillomatosis Treatment

Once an EGD or upper endoscopy shows an esophageal squamous papilloma, the lesion’s size, location, and depth determine how it should be removed. Smaller tumors can be eliminated with biopsy forceps, but larger lesions require endoscopic mucosal resection (EMR). The treatment of esophageal papillomatosis is not known yet. The doctors can cure the disease by some of the following methods:

1. Endoscopic laser therapy: This therapy is utilized for curing advanced tumors that have become cancerous. It helps in removing the blockage in the esophagus by using the laser.
2. Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (EDS): Through this method, the patient is relieved endoscopically without removing the organ.
3. Surgery: This method is efficient for the acute form of esophageal papillomatosis. It helps in removing the cancerous tissues around the esophagus and curing the disease efficiently.
4. Radiation Therapy: In this technique, the tissues are removed by radiation. This procedure involves the removing of the damaged cells by affecting their growth radioactively.

Esophageal papillomatosis is also treated by the following drugs:

1. Imiquimod.
2. 5-fluorouracil.
3. Cantharidin.