Esophageal Stenosis Esophageal Stricture

Overview, Causes, & Risk Factors

An esophageal stricture is a gradual narrowing of the tube that carries food to the stomach. It occurs when scar tissue builds up in the tube.

What is going on in the body?

The esophagus is a muscular tube that connects the throat with the stomach. After food enters the tube, muscles behind and in front of the food contract and relax in a rhythmic sequence to force it along toward the stomach.

When part of the lining of the esophagus is damaged, it may become scarred. This makes it fibrous and stiff. A build-up of scar tissue can gradually cause narrowing of part of the esophagus.

What are the causes and risks of the condition?

A ring of muscle called the lower esophageal sphincter surrounds the opening between the esophagus and the stomach. Normally, it opens to allow food to pass into the stomach. If this sphincter weakens or relaxes so that it cannot close tightly, stomach contents splash back up into the esophagus. This is called gastroesophageal reflux and is the cause of heartburn.

The lining of the esophagus is not designed for this kind of abuse. If the problem is chronic, scar tissue may form and lead to a stricture. Less common causes of stricture include:

  • severe or prolonged infections of the esophagus, known as esophagitis
  • swallowing a caustic substance, such as lye
  • complications of medical treatment, such as pill-induced esophagitis
  • cancer of the esophagus
  • Symptoms & Signs

    What are the signs and symptoms of the condition?

    A person may notice:

  • slowly increasing difficulty in swallowing
  • a feeling that food “gets stuck” in the esophagus
  • uncomfortable, but not painful swallowing
  • stomach contents and acid washing back into the mouth
  • Diagnosis & Tests

    How is the condition diagnosed?

    To diagnose a stricture, the healthcare provider may order:

  • an endoscopy, a procedure in which a narrow tube is inserted into the esophagus to check for scarring or gastroesophageal reflux disease
  • a biopsy, to take a sample of tissue to check for esophageal cancer
  • an x-ray study called a cine-esophagram, in which the person swallows a radio-opaque liquid to help determine the location and length of the stricture
  • Prevention & Expectations

    What can be done to prevent the condition?

    To prevent this condition:

  • A person who has gastroesophageal reflux should talk to his or her healthcare provider about ways to treat it so that scar tissue will not form.
  • A person should avoid swallowing any substance that could harm the esophagus.
  • What are the long-term effects of the condition?

    Even after successful treatment, strictures tend to recur. A stricture caused by drinking lye is thought to be associated with esophageal cancer decades later.

    What are the risks to others?

    There are no risks to others.

    Treatment & Monitoring

    What are the treatments for the condition?

    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 is pushed through the stricture. Every few days or once a week this is repeated with increasingly larger tools until the person finds it easy to swallow again.

    In two other methods of dilation, an endoscope is inserted into the esophagus. Then a flexible-tip guide wire with a dilator or air-filled balloon is passed through the endoscope to enlarge the constricted passageway.

    Gastroesophageal reflux disease must be treated, too, if it has caused a stricture. Long-term treatment with medications known as proton pump inhibitors, such as omeprazole, lansoprazole, or rabeprazole, have been shown to keep these strictures from recurring.

    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.

    What are the side effects of the treatments?

    Problems related to treatment may include:

  • a puncture of the esophagus, or 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.

    Article type: xmedgeneral