Esophageal Stricture: Symptoms, Causes and Treatment

Esophagus is a muscular tube that carries the food from the mouth into the stomach. Esophageal stricture is a medical condition in which the lumen of the esophagus becomes narrow or tighten. It can lead to symptoms like difficulty in swallowing or sensation of fullness in the chest. The strictures can be caused by both noncancerous(benign) as well as cancerous conditions. About 70-80% of all the cases are associated with Gastroesophageal Reflux Disease (GERD) and are benign.

There are about 11,000 new cases of esophageal cancer diagnosed every year.

Causes of Esophageal Stricture

There can be several processes by which it leads to the formation of strictures like

• Continuous irritation of the lining of the esophagus(inflammation)
• Fibrosis of the wall which leads to tightening
• Neoplasia is the abnormal growth which can occur anywhere in the esophagus
• Enlargement of surrounding lymph node can compress the esophagus

These processes are associated with the following conditions

• GERD: Gastroesophageal Reflux Disease is the most common cause of benign strictures in which the lower esophageal sphincter doesn’t tight or close properly and the acid of the stomach flows back into the lower portion of the esophagus. Frequent exposure can lead to scar formation and subsequent fibrosis
• Caustic: the accidental ingestion of the battery acid or other non-corrosive substances can lead to the formation of strictures.
• Radiation therapy to the neck or chest
• Infectious esophagitis due to candida
• Treatment of esophageal varices
• Medication such as NSAIDs, phenytoin, quinine, etc. can also lead to the stricture formation
• Malignancy of esophagus itself or other organs

Signs and Symptoms of Esophageal Stricture

These symptoms arise due to obstruction in the food pathway as well as the underlying condition

• Dysphagia or difficulty in swallowing
• Heartburn (more probably with GERD)
• Regurgitation of food
• Increased frequency of burping
• Unintentional weight loss due to malignancy or the fear of eating
• Sensation of the fullness of the chest
• Complications of Esophageal stricture
• Perforation or bleeding of the wall are the rare complications of the esophageal strictures

Diagnosis of Esophageal Stricture

Your doctor will use your medical history and perform some tests to establish a diagnosis

Medical history: Your doctor will ask you to complete details about your

• Signs and symptoms
• Current or past medications
• Current or previous illnesses
• Family history

Blood tests: a sample of blood is taken to look for the following studies

• Complete blood count: It is to done to check for any low or high counts of any specific cell. Anemia can develop if bleeding is there.
• Liver profile studies: It is done to check for the systemic signs of inflammation

Imaging Studies:

• Barium swallow or upper GI series: The patient is given barium salt to drink. It is a radiopaque material that means it can be easily visualized under x-ray. It gives an outline of the esophagus and help in locating the position and extent of stricture.
• Chest X-ray: A simple chest x-ray can be done to look for the surrounding structures which may compress the esophagus
• CT scan or Ultrasonography can be used to look for any tumor or neoplastic growth
• Upper Endoscopy: Endoscope is a hollow tube that contains light and the camera. It is passed down through your throat to look for the inside features of the esophagus.

Your physician can order other tests also, depending upon the findings of the medical history and the above tests.

Treatment of Esophageal Stricture

The treatment consists of managing the underlying cause and reducing the symptoms

Esophageal dilation: It is a preferred option in most of cases. An endoscope is inserted into the mouth up to the place of stricture and it contains an inflatable balloon at the tip. Once it inflates it will expand the narrowed area in the esophagus.

Stent replacement: A stent is a thin hollow tube made from plastic or metal or flexible mesh material. These are placed in the constructed part and keep the lumen patent.

Medications: The proton pump inhibitor can be used to block the secretion of acid which decreases the effect of acid on stricture formation. It promotes healing of the stricture.

Surgery: surgical procedure may be required if the esophageal dilation and medication are not helping you.

Lifestyle changes:

• You can adopt some changes in your lifestyle which will decrease the risk of having GERD which is the most common cause of esophageal stricture like
• Eating smaller meals
• Losing weight
• Avoiding alcohol and smoking

Prognosis of Esophageal Stricture

About 85% of cases get effective relief of dysphagia after having esophageal dilation but still, 30% of patients may require repeat dilation in the next year. The mortality rate in patients having the stricture related t

o the malignancy is higher than those caused by GERD

Resources:

American Gastroenterological Association