What Are The Presenting Features Of Benign Esophageal Stricture & How Is It Managed?

About Benign Esophageal Stricture:

Esophageal Stricture refers to a pathological condition in which there is abnormal narrowing of the esophagus. The condition in majority of the cases is characterized by inability to swallow solids or liquids which in medical terms is called as dysphagia. Esophageal Stricture is quite a serious condition and requires prompt diagnosis and treatment at its earliest. Esophageal Stricture can be caused due to a variety of reasons of which the common is inflammation. Fibrosis or malignancy also is one of the common causes of Esophageal Stricture.[1]

Esophageal Stricture causes the esophagus to lose its elasticity which may be localized to the site of the narrowing or may involve the entire esophagus. In some cases, endoscopic procedures done for both diagnosis and treatment of certain medical conditions can at times injure the lining of the esophagus causing Esophageal Stricture. This abnormal narrowing can be both benign as well as malignant. Thus an accurate diagnosis of the cause of the Esophageal Stricture is essential for proper treatment of the condition.[2]

Chronic GERD is the primary cause of Esophageal Stricture in majority of the cases. Studies suggest that around 80% of cases of Esophageal Stricture are caused due to longstanding GERD. Studies have also shown that early intervention with PPIs have reduced the incidences of Esophageal Stricture.[1]

In some cases, accidental ingestion of toxic chemicals like house cleaners can also cause Esophageal Stricture. This is seen especially in children. This article details the presenting features of Esophageal Stricture and the management options for it.[1]

What Are The Presenting Features of Benign Esophageal Stricture?

The primary presenting feature of Esophageal Stricture is dysphagia where the affected individual will have difficulty with swallowing any solids or liquids. The individual will feel as if food gets stuck in the throat. It is common for people with Esophageal Stricture to have food regurgitation. In some cases, the individual may have unintentional weight loss. Frequent episodes of heartburn, burping, and hiccups are also common in Esophageal Stricture. Persistent bouts of coughing and choking on food are also seen in people with Esophageal Stricture.[2]

The treatment for Esophageal Stricture is dependent on the cause of the condition. Some of the causes of Esophageal Stricture include:

GERD: This is perhaps the most common cause of Benign Esophageal Stricture. GERD is a gastrointestinal condition in which the food that is consumed regurgitates back up the esophagus to the mouth along with all the stomach acids. This causes the lining of the esophagus to get inflamed and irritated. This results in the esophagus to become narrow or strictured.[2]

Endoscopic Injury: Certain medical conditions require insertion of an endoscope from the mouth trough the esophagus to the stomach to explore the stomach and surrounding structures. This procedure at times can injure the lining of the esophagus and cause Esophageal Stricture.[2]

Chronic NG Tube Use: A nasogastric tube is placed in people who cannot eat orally. This tube passes from the nose through the esophagus to the stomach. Liquid food is fed to the individual from this tube. Chronic use of this tube can often cause Benign Esophageal Stricture.[2]

Hot Liquids: It is also seen that intake of extremely hot liquids can sometimes result in irritation of the esophagus causing Benign Esophageal Stricture.

Esophagitis: This is yet another cause for Benign Esophageal Stricture. Esophagitis occurs as a result of an allergic reaction or severe cases of GERD. It results in inflammation of the esophagus causing Benign Esophageal Stricture.[2]

How is Benign Esophageal Stricture Managed?

Treatment of Benign Esophageal Stricture include:

Medications: For cases of GERD causing Benign Esophageal Stricture, the physician will prescribe proton pump inhibitors. These medications work by reducing the levels of the acids in the stomach and prevent development of acid reflux. This ultimately reduces the risk of future development of Esophageal Strictures.[2]

For cases where infection is believed to be the cause of Esophageal Strictures, then a course of antibiotics will be prescribed. Steroids are the most preferred treatment for Benign Esophageal Stricture caused by esophagitis.[2]

Diet: Certain dietary modifications are essential for treating Benign Esophageal Stricture caused due to GERD. An individual with GERD should avoid eating spicy or greasy food. It is also important to abstain from all forms of tobacco and alcohol to prevent inflammation of the esophagus.[2]

If the affected individual is overweight then shedding off the extra pounds in a healthful way is recommended. It is helpful to eat three small meals a day rather than eating two big meals. It is also advisable to avoid lying down immediately after eating food.[2]

Esophageal Dilation: This is yet another effective way to treat Benign Esophageal Strictures. This procedure involves insertion of an endoscope into the esophagus with a balloon at the tip and inflating the balloon to expand the esophagus and getting rid of the narrowing. In cases of severe narrowing, the patient may require severe rounds of dilation for effective treatment.[2]

However, this treatment comes with a complication of esophageal perforation which may require surgery to correct the problem even though this is seen more in malignant Esophageal Strictures.[2]

Stent Insertion: In some cases, Benign Esophageal Stricture is treated with stent insertion. This not only takes care of the narrowing but also allows the patient to take in more food and liquid than is otherwise not possible in people with Benign Esophageal Strictures.[2]

Surgery: This is only required in rare cases where the symptoms are extremely severe and the quality of the life of the patient becomes miserable due to lack of proper intake of food.[2]

In conclusion, Benign Esophageal Stricture occurs when there is abnormal narrowing of esophagus. It is usually caused when the lining of the esophagus gets inflamed. It usually happens as a result of acid reflux which irritates and inflames the esophagus causing Benign Esophageal Stricture.[2]

There are other causes as well for Benign Esophageal Strictures as well. At times, people who undergo endoscopy for evaluation of the stomach for other medical conditions can irritate the esophagus Benign Esophageal Stricture. Studies however state that 80% of cases of Benign Esophageal Strictures are caused by GERD.[2]

There are a variety of treatments available for treating Benign Esophageal Stricture to include esophageal dilation, stent placement, medications, and dietary modifications. These treatments can treat the condition. However there is always a chance of it recurring. This will require repeat treatments.[2]

Studies suggest that 30% of cases of Benign Esophageal Strictures recur and require repeat dilation within a span of a year. If GERD is the cause of this condition, then the patient will need dietary changes throughout his life to manage the acid reflux and prevent narrowing of the esophagus.[2]

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