Esophageal Stricture

The esophagus is the soft tube that carries food and liquid from the throat to the stomach. Esophageal stricture is a condition where there is a narrowing of the esophagus. The stricture (narrowing) is an abnormal change or possibly an injury causing inflammation or damage to the esophagus. When the damaged areas heal, scar tissue forms making the affected area of the esophagus hard. This narrows the esophagus and causes problems for foods and liquids to pass through.

An esophageal stricture may be benign (not cancerous) or malignant (cancerous). This is based on the abnormal cells that are present in the esophageal stricture. Diagnosing and treating esophageal stricture as soon as possible may relieve its symptoms and prevent other serious health problems.

Causes of Esophageal Stricture

The main causes of esophageal stricture are due to scarring of the esophagus following inflammation or damage caused by acid reflux or hiatal hernia, prolonged use of feeding tubes, accidental or deliberate swallowing of lye or other corrosive chemicals, bulimia, and radiation therapy to throat, neck, or chest.

When caused by chemical damage, the disorder is called corrosive esophagitis. A band of tissue may develop between the damaged linings of the esophagus. This may produce an esophageal web.

Esophageal Stricture due to Acid Reflux

The main cause of esophageal stricture is long-standing acid reflux. This acid irritates and damages the esophagus, which may later lead to scarring and abnormal changes in the cells lining the esophagus. This makes it fibrous and stiff. A build-up of scar tissue can gradually cause narrowing of part of the esophagus

The following are other possible conditions and factors that may increase your risk of having esophageal stricture:

Abnormal esophagus: Some are born with defects in their esophagus, such as stenosis (narrowing) or diverticulosis (pouches).

Esophageal cancer: A malignant tumor of the esophagus may cause it to narrow.

Medicines: Certain medicines may irritate the esophagus, such as aspirin or other pain medicines and antibiotics used for treating malaria.

Surgeries or sclerotherapy: Previous surgeries or sclerotherapy (Sclerotherapy is method of stopping upper gastrointestinal bleeding. A needle is inserted through an endoscope to administer hardening agents to the location that is bleeding).

Trauma: Injury caused by exposure to radiation or swallowing strong acids or bases, such as household cleaning liquids. Trauma may also result from a nasogastric (NG) tube (an NG tube is put into your nose and down into your stomach to keep it empty).

Other diseases: Infections, skin diseases, scleroderma, or esophagitis (swelling of the esophagus) may cause tightening, scarring, or narrowing of the esophagus.

Symptoms of Esophageal Stricture

The symptoms of esophageal stricture are usually related to acid reflux symptoms. Heartburn, the most common symptom of GERD, often coincides with esophageal stricture. You may feel like food gets stuck going down, after swallowing. The symptoms of esophageal stricture may include:

Bitter or acid taste in your mouth.
Black, tarry bowel movements.
Chest pain
Choking, coughing, or shortness of breath.
Frequent burping or hiccups.
Pain or trouble swallowing (dysphagia).
Bringing food back up (regurgitation)
Vomiting blood.
Weight loss.

Diagnosis of Esophageal Stricture

Barium swallow: This test is an x-ray of your throat and esophagus (also called a barium esophagram). The patient drinks a thick liquid called barium which helps the esophagus and stomach show up better on x-rays. Follow the instructions of your caregiver before and after the test.

Computerized tomography scan: This test is also called a CT scan. A special x-ray machine uses a computer to take pictures of your esophagus and other organs. The thickness of the stricture may also be measured using a CT scan.

Endoscopy: This test uses a scope to see the inside of your digestive tract. A scope is a long, bendable tube with a light on the end of it. A camera may be hooked to the scope to take pictures. During an endoscopy, caregivers may find problems with how your digestive tract is working. Samples may be taken from your digestive tract and sent to a lab for tests. Small tumors may be removed, and bleeding may be treated during an endoscopy.

Prevention of Esophageal Stricture

Anyone who has gastroesophageal reflux should talk to their healthcare provider about ways to treat it so that scar tissue will not form. Avoid swallowing any substance that could harm the esophagus and take plenty of water with all prescribed and non-prescribed medicine to avoid damaging the esophagus.

Treatment for esophageal stricture

Treatment depends on the cause of narrowing. For chronic GERD, treatment could include changes in eating habits or drugs to reduce the amount of acid in the stomach. Growths may need surgery. Other treatments may include

Dilation

A dilator, balloon device, or stent may be placed in your esophagus to dilate (widen) it. Usually, strictures are treated by using a tool to dilate or widen the esophagus. A person may be given a local anesthetic to numb the area, then a rigid, tapered device, or a special high-pressure balloon is used to stretch the stricture. This may be repeated with increasingly larger tools until the person finds it easy to swallow again.

Endoscopic therapies

The esophagus may also be made wider by using any of the following therapies:

Ablation: Esophageal stricture may be treated by using a special gas, such as argon, or thermal (heat) energy.

Cautery: A small metal rod that uses electric current is used to burn away abnormal cells.

Injection therapy: Special chemicals, such as alcohol, may be injected into the esophagus to relieve your symptoms.

Laser or photodynamic therapy: Lasers, in combination with medicines that become active when exposed to light, are used to destroy abnormal cells.

Surgery: Surgery may be required if a stricture cannot be dilated enough for solid food to pass through, or if repeated dilations fail to keep it open. Occasionally, a temporary expandable stent (tube) is placed across the stricture to stretch it for several weeks, then removed.

What are the side effects of the treatments?

Problems related to treatment may include

a puncture of the esophagus (esophageal perforation)
a need to change diet to ease swallowing side-effects of medication used to treat gastroesophageal reflux, such as allergic reactions or stomach upset

What happens after treatment for the condition?

In some cases, an esophageal stricture recurs after treatment. After successful treatment, a person can generally go back to regular activities.

How is the condition monitored?

After the esophageal stricture has been treated, the person should report any new symptoms to the healthcare provider.

Esophageal stricture - References