Esophageal Stricture Symptoms and Treatment

An esophageal stricture is a gradual narrowing of the esophagus, which can lead to swallowing difficulties. Healthcare providers diagnose it in about 10 percent of their patients who have gastroesophageal reflux disease (GERD).

Causes

One of the causes of esophageal strictures is gastroesophageal reflux disease, a condition in which excessive acid is refluxed from the stomach up into the esophagus. This causes inflammation in the lower part of the esophagus. Scarring will result after repeated inflammatory injury and healing, re-injury and re-healing. Eventually, the scarring leads to the narrowing of the esophagus. 

Besides GERD, there are other causes of esophageal narrowing, such as:

• Prolonged use of a nasogastric tube (this increases acid levels in the esophagus)
• Ingestion of corrosive substances (for example, household cleaners)
• Viral or bacterial infections that cause esophagitis and then a stricture
• Injuries caused by endoscopes
• Prior surgery on the esophagus (for example, for esophageal cancer)
• Radiation exposure of the esophagus
• Eosinophilic esophagitis
• Pill-induced esophagitis
• Cancer (this is called a malignant stricture)

Symptoms

Common symptoms seen with esophageal stricture include:

• Difficulty swallowing, called dysphagia (may start with solids and then progress to liquids)
• Discomfort with swallowing
• A feeling that food gets stuck in the esophagus or chest area
• Regurgitation of food
• Weight loss

If your esophageal stricture is from GERD, you may also experience heartburn, stomach or chest pain, bad breath, burning sensation in your throat or mouth, cough, sore throat, or a change in your voice. 

Diagnosis

If your healthcare provider is worried about a possible esophageal stricture, two tests are generally ordered: 

• Barium swallow: Patient will swallow a substance called barium and x-rays are taken as the barium moves down the esophagus. If a stricture is present, the barium will move slowly or may get stuck. 
• Endoscopy exam: This is a procedure performed by a gastroenterologist. It entails placing a narrow tube that has a light and camera on it into the mouth, down the esophagus, and into the stomach. It allows the healthcare provider to visualize the inside of your esophagus to see if there is any narrowing or other abnormalities. 

Treatment

The main treatment for esophageal stricture is through a procedure called dilation. In this procedure, the esophagus is stretched by the use of a mechanical dilator or a balloon dilator, which is passed through an endoscope. There is a very low rate of serious complications related to esophageal dilation; when they do occur, they include bleeding and perforation (when a hole forms in the esophagus).

While this therapy treats the vast majority of strictures, repeated dilation may be necessary to prevent the stricture from returning.

Proton pump inhibitors, such as Prilosec (omeprazole), Nexium (lansoprazole) or AcipHex (rabeprazole), can also keep strictures from returning. These are usually prescribed after the procedure if a person is not already taking one. The good news is that after treatment, a person can usually go back to regular routines and diets, although they may develop strictures again in the future, so they have to watch out for recurrent problems swallowing.

Surgical treatment of esophageal stricture is rarely necessary. It is only performed if a stricture can't be dilated enough to allow solid food to pass through. In fact, not getting enough fluids and nutrition is a serious complication of esophageal strictures. Another serious complication is the increased risk of regurgitated food, fluid, or vomit entering the lungs and causing choking or aspiration pneumonia.

Surgery is also performed if repeated dilations do not keep these strictures from returning. Sometimes other procedures are considered when strictures keep recurring, including dilation therapy with steroid injections or stent placement.