Esophageal Stricture

Overview

An esophageal stricture is an abnormal narrowing of the esophagus, the muscular tube that carries food and liquids from the mouth to the stomach. This narrowing can make it difficult to swallow foods and liquids, leading to a sensation that food is stuck in the chest or throat. The condition can range from mild narrowing that causes occasional discomfort to severe constriction that significantly impairs nutrition and quality of life.

Strictures can occur at any point along the esophagus but are most commonly found in the lower third, near the junction with the stomach. They can be benign (non-cancerous) or malignant (cancerous), with benign strictures being more common. The narrowing develops gradually over time, often as a result of chronic inflammation and scarring of the esophageal lining.

The severity of symptoms typically correlates with the degree of narrowing. When the esophageal diameter narrows to less than 13 millimeters, patients usually begin experiencing difficulty swallowing solid foods. Further narrowing can lead to problems with soft foods and eventually liquids. Without treatment, esophageal strictures can lead to malnutrition, weight loss, and aspiration pneumonia.

Symptoms

The symptoms of esophageal stricture typically develop gradually and worsen over time as the narrowing progresses. The primary symptom is dysphagia (difficulty swallowing), which often begins with solid foods and may progress to liquids.

Common Symptoms

Additional Symptoms

• Sensation of food getting stuck in the chest or throat
• Unintentional weight loss
• Dehydration from difficulty drinking liquids
• Increased salivation
• Bad breath (halitosis)
• Coughing or choking when eating
• Recurrent respiratory infections from aspiration

Causes

Esophageal strictures develop when the esophageal lining becomes inflamed and scarred, leading to narrowing of the esophageal lumen. Various conditions can cause this inflammation and scarring:

Common Causes

• Gastroesophageal Reflux Disease (GERD): The most common cause, accounting for 70-80% of benign strictures. Chronic acid exposure leads to inflammation and scarring.
• Eosinophilic Esophagitis: An allergic condition causing inflammation and narrowing of the esophagus
• Radiation Therapy: Treatment for chest or neck cancers can cause radiation-induced strictures
• Chemical Injury: Ingestion of caustic substances (acids or alkalis) causing severe burns
• Medications: Certain pills can cause esophageal injury if they lodge in the esophagus

Less Common Causes

• Esophageal cancer or tumors
• Post-surgical complications (after esophageal surgery)
• Prolonged nasogastric tube placement
• Infectious esophagitis (Candida, herpes, CMV)
• Systemic sclerosis (scleroderma)
• Congenital strictures (present from birth)

Risk Factors

Several factors can increase the risk of developing esophageal strictures:

Diagnosis

Diagnosing esophageal stricture involves a combination of clinical evaluation and imaging studies:

Diagnostic Tests

• Barium Swallow (Esophagram): X-ray study that shows the outline of the esophagus and identifies narrowing
• Upper Endoscopy: Direct visualization of the esophagus to assess the stricture and obtain biopsies
• Esophageal Manometry: Measures pressure and movement patterns in the esophagus
• CT Scan: Provides detailed images to evaluate for tumors or external compression
• Endoscopic Ultrasound: Assesses the esophageal wall layers and surrounding structures

Important Considerations

• Biopsies are essential to rule out malignancy
• The location, length, and diameter of the stricture must be documented
• Multiple strictures may be present
• Associated conditions like GERD or eosinophilic esophagitis should be identified

Treatment Options

Treatment of esophageal stricture aims to relieve symptoms by widening the narrowed area and addressing the underlying cause:

Esophageal Dilation

• Balloon Dilation: A deflated balloon is passed through the stricture and inflated to stretch it
• Bougie Dilation: Progressive dilation using dilators of increasing diameter
• Usually performed under sedation during endoscopy
• May require multiple sessions for optimal results

Medical Management

• Proton Pump Inhibitors (PPIs): To reduce acid reflux and prevent re-stricturing
• Corticosteroids: May be injected into the stricture to reduce inflammation
• Treatment of Underlying Conditions: Managing GERD, eosinophilic esophagitis, etc.

Advanced Treatments

• Esophageal Stenting: Placement of a tube to keep the esophagus open
• Incisional Therapy: Making small cuts in the stricture to allow expansion
• Surgery: Reserved for severe cases or when other treatments fail

Dietary Modifications

• Soft or pureed foods during acute symptoms
• Small, frequent meals
• Thorough chewing
• Avoiding foods that trigger symptoms
• Staying upright after meals

Prevention

While not all esophageal strictures can be prevented, certain measures can reduce the risk:

• Manage GERD effectively with medications and lifestyle changes
• Take medications with adequate water and remain upright
• Avoid lying down immediately after taking pills
• Seek prompt treatment for swallowing difficulties
• Avoid excessive alcohol and quit smoking
• Follow up regularly if you have Barrett's esophagus or other risk factors
• Store caustic substances safely to prevent accidental ingestion

When to See a Doctor

Seek immediate medical attention if you experience:

Schedule an appointment if you have:

• Progressive difficulty swallowing
• Frequent heartburn or acid reflux
• Sensation of food sticking in your chest
• Regurgitation of undigested food
• Chronic cough after eating

Related Conditions

Frequently Asked Questions