What is Benign Esophageal Stricture and How Is It Treated?

What is Benign Esophageal Stricture?

Esophageal Strictures is a pathological condition in which there is narrowing of the esophagus. It is quite a common issue that various gastroenterologists encounter. Esophageal Strictures can be both malignant and benign. Primary esophageal cancer is the primary reason behind malignant Esophageal Strictures even though metastasis from some other part of the body to the esophagus may also result in Esophageal Strictures.[1]

Coming to Benign Esophageal Stricture, it is basically caused by an injury to the esophageal region as a result of radiation therapy to treat some forms of cancer. Peptic injury is yet another cause for Benign Esophageal Stricture. People who are diagnosed with Schatzki’s ring in which there is narrowing of the lower portion of the esophagus causing dysphagia also can develop benign Esophageal Strictures.[1]

Among all the reasons mentioned above, people with GERD are at maximum risk for developing Benign Esophageal Strictures. Esophageal dilation done both diagnostically and therapeutically is the most preferred method for management of Benign Esophageal Strictures. However, to definitively confirm the diagnosis a biopsy of the esophageal tissue is done to rule out any malignancies, especially in people who are at risk.[1]

The primary presenting features of Benign Esophageal Strictures include dysphagia, food regurgitation, and weight loss. Medication, esophageal dilation, and surgery are the treatment options available for treating this condition. Read below to know in detail about the causative factors and various treatment options available for Benign Esophageal Strictures.[2]

How is Benign Esophageal Stricture Treated?

There are various approaches towards management of Benign Esophageal Strictures and the best approach is determined by the underlying cause of the condition. Some of the causative factors for Benign Esophageal Strictures include:[2]

History of GERD: People with a known diagnosis or a past history of GERD are at increased risk for developing Benign Esophageal Strictures. This is because in people with GERD the acid present in the stomach regurgitates back from the stomach to the throat through the esophagus. When this happens, it irritates the lining of the esophagus causing it to get inflamed and narrowed.[2]

Surgical Procedures: Certain procedures especially endoscopy where a surgeon inserts an endoscope from the mouth through the esophagus into the stomach can cause an injury. This injury can lead to inflammation and resultant narrowing of the esophagus causing Benign Esophageal Strictures.[2]

NG Tube Placement: An NG tube is usually given for chronically ill patients who cannot eat anything by mouth. This tube is inserted through the mouth via the esophagus into the stomach. Chronic use of this tube also tends to cause inflammation and resultant Benign Esophageal Strictures.[2]

Swallowing Toxins: Some people tend to swallow toxic material like housecleaning products. This can severely damage the esophagus and cause Benign Esophageal Strictures. Drinking extremely hot or cold fluids also at times lead to Benign Esophageal Strictures.[2]

Esophagus Varices: This is a condition in which the veins in the esophagus become swollen. This requires aggressive treatment. The treatment given for esophageal varices increases the risk for the patient developing Benign Esophageal Strictures.[2]

Coming to the treatment options for Benign Esophageal Strictures, the options include:

Medications: If GERD is the primary cause for the abnormal narrowing and inflammation of the esophagus then proton pump inhibitors will be prescribed. These medications decrease the quantity of the stomach acid which not only treats GERD but also calms down the inflammation and clears the narrowing of the esophagus.[2]

Antibiotics are prescribed if the cause of Benign Esophageal Strictures is believed to be a bacterial infection. Severe inflammation of the esophagus is sometimes treated with tapered doses of steroids.[2]

Dietary and Lifestyle Modifications: Along with medications, dietary modifications are also required for treating Benign Esophageal Strictures, especially if GERD is believed to be the cause of the condition. The dietary changes recommended include complete avoidance of spicy and fatty food. Complete avoidance of caffeine, alcohol, tobacco, and chocolate is also recommended. It is also recommended two eat three to four small meals every day rather than two big meals.[2]

Certain lifestyle modifications can also help with the symptoms of Benign Esophageal Strictures. These changes include shedding off extra weight by healthy means, wearing clothes that do not put pressure on the stomach. It is also helpful to avoid lying down immediately after eating to prevent any acidic regurgitation.[2]

Esophageal Dilation: This is perhaps the most favored treatment for Benign Esophageal Strictures. Esophageal dilation involves insertion of an endoscope that is attached to a dilator or a balloon into the esophagus. The balloon is then inflated inside the esophagus and the narrowed part is widened. The number of dilations required varies depending on the severity of the stricture.[2]

This procedure however has a possible complication of esophageal perforation in which while inserting the endoscope in the esophagus it may create a puncture or a hole in the esophagus which will require additional treatment. This complication however is very rare in Benign Esophageal Strictures.[2]

Stent Placement: To widen the narrowed part of the esophagus, sometimes physicians also resort to stent placement. This will widen the esophagus and allow the patient to eat and drink more easily and treat dysphagia caused by Benign Esophageal Strictures.[2]

In Conclusion: Benign Esophageal Strictures causes the esophagus to become narrow causing a variety of symptoms like dysphagia and acid reflux. The treatment for Benign Esophageal Strictures depends on the underlying cause and range from medications to stent placement to widen the esophagus.[2]

While treatments for Benign Esophageal Strictures are extremely effective, this condition has a very high rate of recurrence. This is the reason why many people require multiple dilation procedures to keep the esophagus wide.[2]

According to a study, around 30-35% of people who have had dilation for Benign Esophageal Stricture might require a repeat procedure within a year. Dietary and lifestyle modifications are essential for people with a history of GERD to prevent any worsening of symptoms caused due to Benign Esophageal Strictures.[2]

References:  

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