An esophagealstrictureis a gradual narrowing of the esophagus, which can lead to swallowing difficulties.
Healthcare providers diagnose it in about 10 percent of people withgastroesophageal reflux disease(GERD).
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Causes
One cause of esophageal strictures is gastroesophageal reflux disease, a condition in which excessive acid is refluxed from the stomach up into the esophagus, causing inflammation in the lower part of the esophagus.
Scarring results after repeated inflammatory injuries and healing, including re-injury and re-healing. Eventually, the scarring narrows the esophagus.
Besides GERD, there are other causes of esophageal narrowing, such as:
Symptoms
Common symptoms seen with esophageal stricture include:
If your esophageal stricture is from GERD, you may also experience heartburn, stomach or chest pain, bad breath, burning sensation in your throat or mouth, cough, sore throat, or a change in your voice.
Diagnosis
If your healthcare provider is worried about a possible esophageal stricture, two tests are generally ordered:
Treatment
The main treatment for esophageal stricture is dilation. In this procedure, the esophagus is stretched using a mechanical dilator or a balloon dilator passed through an endoscope.
There is a very low rate of serious complications related toesophageal dilation; when they do occur, they include bleeding and perforation (when a hole forms in the esophagus).
While this therapy treats the vast majority of strictures, repeated dilation may be necessary to prevent the stricture from returning.
A recurring stricture occurs in about 30% of people after dilation within the first year, according to aresearch paperinCurrent Treatment Options in Gastroenterology.
Proton pump inhibitors, such as Prilosec (omeprazole), Nexium (lansoprazole) or AcipHex (rabeprazole), can also keep strictures from returning. They may be prescribed before the dilation procedure to decrease inflammation and reduce surgical risks. These are usually also prescribed after the procedure if a person is not already taking one.
The good news is that a person can usually return to regular routines and diets after treatment. However, they may develop strictures again, so they have to watch out for recurrent swallowing problems.
Surgical treatment of esophageal stricture is rarely necessary. It is only performed if a stricture can’t be dilated enough to allow solid food to pass through.In fact, not getting enough fluids and nutrition is a serious complication of esophageal strictures. Another serious complication is the increased risk of regurgitated food, fluid, or vomit entering the lungs and causing choking or aspiration pneumonia.
Surgery is also performed if repeated dilations do not keep these strictures from returning. Sometimes, other procedures are considered when strictures keep recurring, including dilation therapy with steroid injections or stent placement.
10 Sources
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Esophageal stricture - benign. US National Library of Medicine.
Agarwalla A, Small AJ, Mendelson AH, Scott FI, Kochman ML.Risk of recurrent or refractory strictures and outcome of endoscopic dilation for radiation-induced esophageal strictures.Surg Endosc. 2015;29(7):1903-12. doi:10.1007/s00464-014-3883-1
Carucci LR, Turner MA.Dysphagia revisited: common and unusual causes.Radiographics. 2015;35(1):105-22. doi:10.1148/rg.351130150
Esophageal strictures. Boston Children’s Hospital.
GERD (Chronic Acid Reflux). Cleveland Clinic.
Esophageal Stricture. Columbia University Department of Otolaryngology Head and Neck Surgery.
National Library of Medicine.Esophageal stricture.
Van boeckel PG, Siersema PD.Refractory esophageal strictures: what to do when dilation fails.Curr Treat Options Gastroenterol. 2015;13(1):47-58. doi:10.1007/s11938-014-0043-6
Fass R.Approach to the evaluation of dysphagia in adults. UpToDate, Feldman M (Ed), UpToDate, Waltham, MA.
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