Patient will present with → solid food dysphagia in a patient with a history of GERD
Dysphagia to solids that is only gradually progressive is suggestive of an esophageal stricture. GERD accounts for approximately 70-80% of all cases of esophageal stricture.
- Esophageal web: thin membranes in the mid-upper esophagus. May be congenital or acquired
- Plummer-Vinson: esophageal webs + dysphagia + iron deficiency anemia
- A Schatzki ring is a diaphragm-like mucosal ring that forms at the esophagogastric junction (the B ring). If the lumen of this ring becomes too small, symptoms occur. The cause is not clear, but such rings are usually found in older individuals and have been observed in 6% to 15% of patients undergoing a barium swallow study; however, only 0.5% of those being examined have significant symptoms. Symptoms correlate with the size of the lumen of the ring: a lumen of more than 20 mm in diameter provides few if any symptoms; if it is less than 13 mm in diameter, chronic and more severe symptoms occur.
- Most patients have intermittent, gradually progressive dysphagia for solid food that occurs while consuming a heavy meal with meat that was “wolfed down,” hence the pseudonym the “steakhouse syndrome.”
- Sometimes the meal is regurgitated, relieving the block, and eating can be resumed. Patients with a Schatzki ring are also at risk for GERD.
Diagnosed by upper endoscopy to determine the underlying cause, exclude malignancy, and perform therapy (dilation) if needed
- Barium contrast esophagram (barium swallow) can be used as the initial test (prior to upper endoscopy) in patients with clinical features of proximal esophageal lesion or known complex (tortuous) stricture
Endoscopy and dilatation rarely patients will need surgery
Corrosive strictures account for less than 5% of all cases of esophageal stricture.
Gastroesophageal reflux disease (GERD)
Postoperative scarring account for about 10% of all cases of esophageal stricture
Esophageal cancer is not the most common cause of esophageal stricture.
Achalasia is a possible cause, but the history of GERD makes strictures the most likely diagnosis.
Diffuse esophageal spasm (DES)
DES is also a possible cause, but the history of GERD makes strictures the most possible cause.
Pyloric stenosis occurs in neonates/infants.
Proton Pump Inhibitor
is used in the initial treatment of esophageal stricture
is a definitive treatment
Endoscopic intralesional steroid
commonly used for refractory strictures.
both solids and liquids
A solid tumor