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Esophageal Stricture

Alternate Names

  • esophageal stenosis
  • Stricture of the esophagus

Definition

An esophageal stricture is a gradual narrowing of the tube that carries food to the stomach. It occurs when scar tissue builds up in the tube.

What is going on in the body?

The esophagus is a muscular tube that connects the throat with the stomach. After food enters the tube, muscles behind and in front of the food contract and relax in a rhythmic sequence to force it along toward the stomach.
When part of the lining of the esophagus is damaged, it may become scarred. This makes it fibrous and stiff. A build-up of scar tissue can gradually cause narrowing of part of the esophagus.

Risks

What are the causes and risks of the condition?

A ring of muscle called the lower esophageal sphincter surrounds the opening between the esophagus and the stomach. Normally, it opens to allow food to pass into the stomach.
If this sphincter weakens or relaxes too frequently, stomach contents splash back up into the esophagus. This is called gastroesophageal reflux (GERD) and is the cause of heartburn. The esophagus is hurt by the repeated burning of the misplaced acid.
If the problem is chronic, scar tissue may form and lead to a stricture. Less common causes of stricture include:
  • severe or prolonged infections of the esophagus, known as esophagitis
  • swallowing a caustic substance, such as lye
  • complications of medical treatment, such as pill-induced esophagitis (aspirin, ibuprofin, tetracycline)
  • cancer of the esophagus

Prevention

What can be done to prevent the condition?

  • A person who has gastroesophageal reflux should talk to his or her healthcare provider about ways to treat it so that scar tissue will not form.
  • A person should avoid swallowing any substance that could harm the esophagus.
  • A person should be sure to wash all prescribed and non-prescribed medicine down well with fluids or food.

Diagnosed

How is the condition diagnosed?

To diagnose a stricture, the healthcare provider may order:
  • an endoscopy, a procedure in which a narrow tube is inserted into the esophagus to check for scarring or gastroesophageal reflux disease
  • a biopsy, to take a sample of tissue to check for esophageal cancer
  • an x-ray study called a cine-esophagram or barium swallow, in which the person swallows a dye-like liquid to help determine the location and length of the stricture

Long Term Effects

What are the long-term effects of the condition?

Even after successful treatment, strictures may recur. A stricture caused by drinking lye is thought to be associated with esophageal cancer decades later.

Other Risks

What are the risks to others?

There are no risks to others.

Treatments

What are the treatments for the condition?

Usually, strictures are treated by using a tool to dilate or widen the esophagus. A person may be given a local anesthetic to numb the area. Then a rigid, tapered device, or a special high-pressure balloon is used to stretch the stricture. Periodically this may have to be repeated with increasingly larger tools until the person finds it easy to swallow again.
Gastroesophageal reflux disease must also be treated if it has caused a stricture. Long-term treatment with medications known as proton pump inhibitors, such as omeprazole (i.e., Prilosec), lansoprazole (i.e., Prevacid), esomeprazole (i.e., Nexium), pantoprazole (i.e., Protonix), or rabeprazole (i.e., Aciphex), have been shown to keep these strictures from recurring.
Surgery may be required if a stricture cannot be dilated enough for solid food to pass through, or if repeated dilations fail to keep it open. Occasionally, a temporary expandable stent (tube) is placed across the stricture to stretch it for several weeks, then removed.

Side Effects

What are the side effects of the treatments?

Problems related to treatment may include:
  • a puncture of the esophagus (esophageal perforation)
  • a need to change diet to ease swallowing
  • side effects of medication used to treat gastroesophageal reflux, such as allergic reactions or stomach upset

After Treatment

What happens after treatment for the condition?

In some cases, an esophageal stricture recurs after treatment. After successful treatment, a person can generally go back to regular activities.

Monitor

How is the condition monitored?

After the esophageal stricture has been treated, the person should report any new symptoms to the healthcare provider.

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