GI Conditions
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      2. GI Conditions

      Esophageal Stricture

      Brief Overview: Esophageal stricture is a narrowing of the esophagus that causes dysphagia (difficulty swallowing). It is most often associated with chronic GERD. Esophageal strictures are typically treated with esophageal dilation and PPIs.

      Prevalence: According to one study, “Esophageal strictures are common, affecting between 1/100 and 1/1000 patients in the United States, with the highest rates seen in patients aged 75 years and older.”

      Etiology: Inflammation, damage, and scarring in the esophagus lead to narrowing and stricture. The most common cause is GERD. Other causes can be chronic esophagitis, injury to the esophagus, esophageal cancer, among others.

      Risk Factors:

      • Chronic inflammation of the esophagus (GERD)
      • Therapeutic interventions (surgical resection, radiofrequency ablation, endoscopic resection including endoscopic mucosal resection and endoscopic submucosal dissection)
      • Ingestion of caustic agents (ex: sodium or potassium hydroxide contained in drain cleaner and other household cleaning products, disc batteries)
      • Cancer

      Commonly Associated Conditions:

      • GERD
      • Eosinophilic esophagitis
      • Dermatologic disease: epidermolysis bullosa, lichen planus, pemphigus
      • Barrett’s esophagus

      Common Medications:

      • Proton Pump Inhibitor (PPI) following esophageal dilation – omeprazole, pantoprazole, esomeprazole, lansoprazole rabeprazole

      Common Labs, Imaging, and Tests:

      • Barium swallow
      • Endoscopy
      • Mucosal biopsy for some patients

      Common Symptoms:

      • Dysphagia – difficulty swallowing. Dysphagia can progress from difficulty swallowing solids, to difficulty swallowing liquids also
      • Feeling like food or solids get stuck in your throat
      • Heartburn
      • Regurgitation (food coming back up)
      • Weight loss
      • Painful swallowing

      Common Treatments:

      • Esophageal dilation via endoscopy
      • PPI
      • Treatment of any underlying cause

      Physical Findings:

      • Typically, normal physical exam
      • Weight loss possible

      Potential Complications and Contraindications:

      • Recurrence of symptoms and/or need for multiple esophageal dilation procedures
      • Food impaction requiring emergency removal
      • Aspiration pneumonia from regurgitated food
      • Bleeding or perforation from repeated dilations

      General Health and Lifestyle Guidance:

      • Eat soft, moist foods and chew thoroughly
      • Avoid sticky, dry, or bulky foods that may get stuck
      • Elevate the head of the bed and avoid eating before lying down (for reflux)
      • Stop smoking and limit alcohol
      • Maintain a healthy weight to reduce reflux
      • Take PPIs consistently as prescribed
      • Avoid triggers like spicy or acidic foods if GERD is a factor

      Suggested Questions to Ask Patients:

      • Do you have trouble swallowing or feel like food gets stuck?
      • Have you had frequent heartburn or acid reflux?
      • Have you experienced/noticed any unintentional weight loss?
      • Do you need to cut food into small pieces or avoid certain textures?
      • Have you had any previous endoscopies or esophageal procedures?

      Suggested Talking Points:

      • Work with your healthcare provider to manage any underlying causes of your esophageal stricture
      • Avoid any known trigger foods
      • Discuss any recommended dietary modifications with your healthcare provider
      • Take any medications as prescribed by your healthcare provider

       

      Sources: