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Esophageal stricture
Esophageal stricture
Other names	Peptic stricture
	Endoscopic image of a benign peptic stricture
Specialty	Gastroenterology; General surgery

A benign esophageal stricture, or peptic stricture,^[1] is a narrowing or tightening of the esophagus that causes swallowing difficulties.

Signs and symptoms

Symptoms of esophageal strictures include heartburn, bitter or acid taste in the mouth, choking, coughing, shortness of breath, frequent burping or hiccups, pain or trouble swallowing, throwing up blood, or weight loss.^[2]

Causes

It can be caused by or associated with gastroesophageal reflux disease,^[1] esophagitis, a dysfunctional lower esophageal sphincter, disordered motility, lye ingestion, or a hiatal hernia. Strictures can form after esophageal surgery and other treatments such as laser therapy or photodynamic therapy. While the area heals, a scar forms, causing the tissue to pull and tighten, leading to difficulty in swallowing.^[3]

Diagnosis

It can be diagnosed with an X-ray while the patient swallows barium (called a barium study of the esophagus), by a computerized tomography scan, a biopsy,^[4] or by an endoscopy.

Treatment

If it is caused by esophagitis, in turn caused by an underlying infection, it is commonly treated by treating the infection (typically with antibiotics). In order to open the stricture, a surgeon can insert a bougie – a weighted tube used to dilate the constricted areas in the esophagus.^[3] It can sometimes be treated with other medications. For example, an H2 antagonist (e.g. ranitidine) or a proton-pump inhibitor (e.g. omeprazole) can treat underlying acid reflux disease.

Epidemiology

Gastroesophageal reflux disease (GERD) affects approximately 40% of adults. Strictures occur in 7–23% of patients with GERD who are untreated.^[5]

References

^ ^a ^b Shaker, Reza; Belafsky, Peter C.; Postma, Gregory N.; Easterling, Caryn, eds. (27 September 2012). Principles of Deglutition. Springer Science & Business Media. p. 746. ISBN 978-1-4614-3794-9. Retrieved 26 June 2016. Chronic GERD is the most common etiology of benign esophageal strictures, referred to as peptic strictures.
^ PDRhealth – Esophageal Stricture: (http://www.pdrhealth.com/disease/disease-mono.aspx?contentFileName=ND7417G.xml&contentName=Esophageal+Stricture&contentId=506&TypeId=2)
^ ^a ^b Ginex, Pamela K., Manjit S. Bains, Jacqueline Hanson, and Bart L. Frazzitta. 100 Questions & Answers About Esophageal Cancer (100 Questions & Answers). New York: Jones and Bartlett, Inc., 2005. Print.
^ Craner, David J. "Esophageal Strictue". Discovery Health.
^ Esophageal Stricture at eMedicine