Abstract: Objective This study aims to analyze and summarize the clinical features of esophageal tuberculosis patients, thereby providing a reference basis for the early identification, diagnosis and treatment of esophageal tuberculosis. Method A retrospective analysis was conducted on clinical data from 20 patients diagnosed with and treated for esophageal tuberculosis at Public Health Clinical Center of Chengdu between January 2019 and December 2024. Data on demographic characteristics, clinical symptoms, underlying diseases and comorbidities, imaging findings, endoscopic examinations and observations, and pathological results were systematically collected through the hospital's electronic medical record system to analyze the clinical features of the patients. Result The main clinical manifestations of the 20 patients with esophageal tuberculosis were retrosternal pain (9 patients), dysphagia (7 patients), anorexia (5 patients), and cervical masses (4 patients). Of note, 6 patients presented with no gastrointestinal symptoms. On computed tomography, common radiographic features included esophageal wall thickening or luminal narrowing (9 patients) and mediastinal lymphadenopathy (14 patients). Most lesions were located in the upper and middle segments of the esophagus. Endoscopic examination primarily revealed ulcerations, submucosal protrusions, and fistulous openings in the esophageal wall. Histopathological analysis of esophageal mucosal biopsies demonstrated granulomatous inflammation in 15 patients. Among those who underwent specific pathogen testing, the positivity rates for acid-fast bacilli (AFB) staining and Mycobacterium tuberculosis polymerase chain reaction in lesional tissues were 12.5% (1/8) and 83.3% (5/6), respectively. A confirmed diagnosis, based on the presence of typical tuberculous granulomas along with microbiological evidence, was established in 7 patients. The remaining 13 patients received a clinical diagnosis supported by integrated assessment of clinical presentation, imaging, endoscopic, and histopathological findings. Conclusion Esophageal tuberculosis is characterized by atypical clinical presentations and non-specific imaging features, leading to frequent missed diagnosis and misdiagnosis due to its deceptive presentation. In clinical practice, an integrated diagnostic approach combining endoscopy, histopathology, and etiological examination is essential. Early recognition, accurate diagnosis, and standardized treatment are crucial for improving prognosis.

Key words: Esophageal tuberculosis, Clinical features, Retrospective analysis