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Esophageal stricture

Esophageal Stricture

An esophageal stricture is a narrowing of the esophagus, the passageway from the throat to the stomach. Stomach acid as a product of GERD, radiation treatments to the head and neck, and other irritants may injure the esophageal lining, causing inflammation (esophagitis) and the formation of scar tissue. This may gradually lead to narrowing of the esophagus and obstruction of the esophagus, making swallow difficult or even impossible in extreme cases.

What Causes Esophageal Stricture?

  • Persistent reflux of gastric acid into the esophagus or gastroesophageal reflux disease (GERD)
  • Systemic sclerosis (scleroderma), which is often associated with severe reflux and esophageal stricture
  • Pills lodged in the esophagus or medications that can chronically irritate the esophagus
  • Esophageal surgery or protracted use of a nasogastric tube (used in hospitals for feeding)
  • Esophageal cancer may narrow the esophagus and produce the same symptoms
  • Accidental injury caused by an endoscope

Symptoms of Esophageal Stricture

  • Progressive swallowing difficulty, first with solid foods, then liquids; chest pain after meals; and increased salivation (not common in oral cancer patients treated with radiation)
  • Regurgitation of foods and liquids. These may be aspirated into the lungs, causing cough, wheezing, and shortness of breath.
  • Weight loss
  • Dehydration
  • Cough, particularly at night

Prevention of Esophageal Stricture

  • Aggressive treatment of chronic gastroesophageal reflux is necessary. Often this is a combination of proton pump inhibitor drugs, and H2 acid blocking drugs
  • Take all medications with a full glass of liquid to ensure none stays in the esophagus.

Diagnosis of Esophageal Stricture

  • A medical history and physical examination are performed.
  • Barium x-ray studies. You may be required to swallow barium, which helps to create a sharp image of the esophagus on an x-ray (fluoroscope).
  • Endoscopy (insertion of an illuminated scope into the esophagus through the mouth under local anesthesia) may be performed.

How to Treat Esophageal Stricture

  • Your doctor may advise a diet of liquids or soft foods until food can be swallowed without difficulty.
  • Mechanical dilation of the esophagus (esophageal bougienage) may be performed to widen the stricture.
  • Rx Proton pump inhibitors in combination with H2 acid-blocking medicines are used to prevent esophageal strictures caused by GERD from recurring.
  • In severe cases the affected portion of the esophagus may be removed and replaced with a segment of the large intestine.
  • In a few cases patients who are unsuited for surgery may have a feeding tube inserted through the stricture. Alternatively, such patients may have a small PEG feeding tube placed into the stomach so that food may bypass the esophagus completely.

Surgical tightening of the pyloric sphincter where the stomach and the esophagus connect, through a Nissen fundoplication procedure.