Patient will present with → solid food dysphagia in a patient with a history of GERD
Esophageal web: thin membranes in the mid-upper esophagus. May be congenital or acquired
- Plummer-Vinson: esophageal webs + dysphagia + iron deficiency anemia
Strictures are often due to scarring from the healing process of ulcerative esophagitis
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 an intermittent, nonprogressive 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.
- A diagnosis is confirmed by radiographic barium swallow or endoscopic means, and if symptoms are sufficiently troublesome, the treatment of choice is rupture of the ring by dilation.
Barium swallow (meal, esophagram) is the diagnostic test of choice for esophageal webs
Endoscopy and dilatation rarely will you 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