Esophageal Stricture

Esophageal stricture is a condition where there is a narrowing of the esophagus that causes swallowing problems. The esophagus is the soft tube that carries food to the stomach, and any changes or injury to the esophagus can cause swelling (inflammation) and damage. When the damage heals, scar tissues form and make the area hard. This narrows the esophagus and causes swallowing problems.

The main cause of esophageal stricture is a bad long-standing gastroesophageal reflux disease (GERD). Heartburn is the most common symptom of GERD where there is a burning feeling after meals that spread to the neck, jaw, chest or shoulder. Food feels like it is stuck going down after swallowing. Other conditions and factors that may increase the risk of esophageal stricture include:

  • Abnormal esophagus: defects in the esophagus, such as narrowing (stenosis) or pouches (diverticulosis).
  • Esophageal cancer: a malignant tumor may cause the narrowing.
  • Medicines: certain medicines may irritate the esophagus, such as aspirin and other pain medicines, antibiotics used for treating malaria, and acne medicine such as Doxycycline.

Other symptoms may include:

  • Bitter or acid taste in the mouth.
  • Black, tarry bowel movements.
  • Choking, coughing, or shortness of breath.
  • Frequent burping or hiccups.
  • Pain or trouble swallowing.
  • Throwing up (vomiting) blood.
  • Weight loss.

Testing

One or more of the following tests can be done:

  • Endoscopy: a scope with a long bendable tube with a light is sent down the esophagus. Samples can be taken and sent to the lab for testing. Small tumors may be removed, bleeding can be treated, and the esophagus can be dilated.
  • Barium swallow: a thick liquid called barium is swallowed while x-ray is taken of esophagus.
  • CT scan: a special x-ray is used to measure thickness of the stricture.

Treatment

Dilation (stretching) of the esophagus is the preferred treatment. Acid-blocking medicines (proton pump inhibitors) can also be used to keep a peptic stricture from returning. Surgical treatment is rarely needed.

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esophageal stricture pre-dilation
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stricture during dilation with mucosal stretching
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esophagus pos-dilation