Patient will present with → solid food dysphagia in a patient with a history of GERD
An esophageal stricture is an abnormal tightening or narrowing of the esophagus making it more difficult for food to travel down the tube. People with esophageal strictures may have pain or difficulty swallowing
- It can be caused by or associated with gastroesophageal reflux disease, esophagitis, a dysfunctional lower esophageal sphincter, disordered motility, or a hiatal hernia
- Strictures can form after esophageal surgery and other treatments such as laser therapy or photodynamic therapy
- Dysphagia to solids that is only gradually progressive is suggestive of an esophageal stricture
- The majority of esophageal strictures result from benign peptic strictures from long-standing gastroesophageal reflux disease (GERD), which accounts for 70 to 80% of adult cases
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
- It can sometimes be treated with other medications. For example, an H2 antagonist or a proton-pump inhibitor (e.g. omeprazole) can treat underlying acid reflux disease
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