II. Definitions

  1. Esophageal Stricture
    1. Abnormal narrowing of the esophageal lumen

III. Epidemiology

  1. Incidence: 1.1 per 10,000
  2. Ten times more common in white patients than black or asian patients

IV. Pathophysiology

  1. Narrowing in the esophageal lumen due to inflammation, neoplasm, fibrosis or injury
  2. Dysphagia occurs when esophagus narrows to <13 mm from normal 20 mm size in adults

V. Risk Factors

VI. Causes

  1. Neoplasm (e.g. Esophageal Cancer)
  2. Gastroesophageal Reflux (GERD)
    1. Benign peptic strictures form with longstanding GERD
    2. Responsible for up to 70% of Esophageal Strictures in adults
  3. Injury
    1. Post-procedural Esophageal Stricture (e.g. upper endoscopy)
    2. Ingested hot or toxic liquid or solid (e.g. corrosive liquid ingestion in children)
    3. Radiation Therapy (cervical and thoracic regions)
    4. Prolonged Nasogastric Tube or Orogastric Tube
  4. Eosinophilic Esophagitis
    1. Higher risk of stricture with prolonged untreated disease
  5. Pill Esophagitis (e.g. NSAIDs, Doxycycline)
    1. Prolonged use of causative medications
  6. Viral Infections (esp. Immunocompromised)
    1. Cytomegalovirus (CMV)
    2. Herpes Simplex Virus (HSV)
    3. Human Immunodeficiency Virus (HIV)
    4. Esophageal Candidiasis
  7. Miscellaneous
    1. Collagen Vascular Disease
    2. Esophageal Ring or Esophageal Web
    3. Crohn Disease
    4. Tuberculosis

VII. Symptoms

  1. Solid food Dysphagia (may progress to liquid Dysphagia)
  2. Food impaction
  3. Odynophagia
  4. Chest Pain
  5. Weight loss

VIII. Differential Diagnosis

  1. See Esophageal Dysphagia
  2. External esophageal compression (e.g. thoracic mass)
  3. Esophageal Spasm
  4. Achalasia
  5. Esophageal Cancer

IX. Diagnosis

  1. Upper Endoscopy (EGD) is preferred
    1. Allows for direct visualization and biopsy
    2. Endoscopic Ultrasound may be performed to evaluate lesion depth
  2. Barium swallow
    1. May be considered when upper endoscopy is not readily available
    2. Test Sensitivity: 95% for Esophageal Stricture
  3. Other imaging
    1. Chest XRay or CT Chest
      1. Consider for excluding alternative diagnoses (e.g. external compression)

X. Grading: Dysphagia Scoring System

  1. Score 0: No Dysphagia
  2. Score 1: Moderate passage - able to eat some solid food
  3. Score 2: Poor passage - able to eat only semi-solid food
  4. Score 3: Very poor passage - able to swallow only liquids
  5. Score 4: No passage - unable to swallow anything

XI. Management

  1. First-line measures
    1. Esophageal Dilation (push/bougie or balloon)
    2. Intralesional Corticosteroid (adjunctive to dilation, refractory cases)
  2. Refractory case measures
    1. Esophageal Stent such as self-expanding metal stent or SEMS (esp. in malignancy)
    2. Surgical resection (esp. in malignancy)
  3. Maintenance management
    1. Proton Pump Inhibitor (PPI, e.g. Omeprazole) longterm use

XII. Complications

  1. Food Impaction
  2. Aspiration
  3. Esophageal Perforation
  4. Esophageal fistula

XIII. References

  1. Moustarah (2020) StatPearls, accessed 9/24/20
  2. Pasha (2014) Gastrointest Endosc 79(2): 191-201 [PubMed]

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Related Studies

Ontology: Esophageal Stenosis (C0014866)

Definition (NCI) Narrowing of the lumen of the esophagus.
Definition (NCI_CTCAE) A disorder characterized by a narrowing of the lumen of the esophagus.
Definition (MSH) A stricture of the ESOPHAGUS. Most are acquired but can be congenital.
Concepts Disease or Syndrome (T047) , Anatomical Abnormality (T190)
MSH D004940
ICD9 530.3
ICD10 K22.2
SnomedCT 253760004, 63305008, 155675001, 196611002, 204651000, 196613004, 33282003, 360433005, 307388000, 307503005, 912005
English Esophageal Stenoses, Stenoses, Esophageal, Esophageal Stricture, Stricture, Esophageal, ESOPHAGEAL STRICTURE, OESOPHAGEAL STRICTURE, Esophageal strict./stenos.NOS, Esophageal stricture and stenosis NOS, Oesophageal strict./stenos.NOS, Oesophageal stricture and stenosis NOS, Esophageal stricture and stenosis, Esophageal stricture/stenosis, Oesophageal stricture and stenosis, Oesophageal stricture/stenosis, esophageal stricture (diagnosis), esophageal stricture, esophageal stenosis (diagnosis), esophageal stenosis, Esophageal Stenosis [Disease/Finding], Esophagostenosis, Stenosis of oesophagus, Oesophagostenosis, Stenosis of esophagus, Esophageal Stenosis, stricture esophagus, stricture of esophagus, esophageal strictures, oesophagus strictures, esophagostenosis, esophagus stricture, oesophagus stenosis, stenosis esophageal, stenosis of esophagus, Stricture;oesophageal, esophagus stenosis, congenital esophageal stenosis, esophagus strictures, stenosis oesophagus, stricture oesophagus, Esophageal strictures, Stenosis - oesophagus, Stenosis - esophagus, Esophagostenosis (disorder), Esophageal stenosis (disorder), Esophageal stricture and stenosis NOS (disorder), Stricture - oesophagus, Stricture - esophagus, Esophageal stricture and stenosis (disorder), Stenosis of esophagus (disorder), Esophagus--Stenosis, Stricture of esophagus, Esophageal stricture, Oesophageal stricture, Stricture of oesophagus, Stricture of esophagus (disorder), esophagus; stenosis, esophagus; stricture, stenosis; esophagus, stricture; esophagus, Stenosis, Esophageal, Esophageal stenosis, Oesophageal stenosis, Stenosis esophageal, Stricture esophagus, Stricture and stenosis of oesophagus, Stenosis oesophageal, Stricture oesophagus, Stricture and stenosis of esophagus, Stricture;esophageal, oesophageal stricture
Portuguese ESTENOSE ESOFAGICA, Aperto e estenose do esófago, Aperto do esófago, Aperto esofágico, Estenose do esófago, Estrangulamento Esofágico, Estenose esofágica, Estenose Esofágica, Estreitamento do Esôfago
Dutch slokdarmvernauwing, stenose oesofageaal, oesofageale stenose, oesofagusstrictuur, strictuur oesofagus, strictuur en stenose van oesofagus, strictuur en stenose van slokdarm, vernauwing van slokdarm, strictuur van oesofagus, oesofagus; stenose, oesofagus; strictuur, stenose; oesofagus, strictuur; oesofagus, slokdarmstenose, Oesofagusstenose, Slokdarmstenose, Stenose, slokdarm-, Strictuur, oesofageale
French Rétrécissement de l'oesophage, Rétrécissement et sténose de l'oesophage, Constriction et sténose de l'oesophage, STENOSE OESOPHAGIENNE, Sténose oesophagienne, Rétrécissement oesophagien, Sténose de l'oesophage
German Striktur des Oesophagus, Stenose des Oesophagus, Striktur und Stenose des Oesophagus, Speiseroehrenstriktur, OESOPHAGUSSTRIKTUR, Oesophagusstenose, Ösophagusstenose, Ösophagusstriktur, Stenose, Ösophagus-
Italian Restringimento dell'esofago, Stenosi dell'esofago, Restringimento esofageo, Stenosi dell'esofagea, Restringimento e stenosi dell'esofago, Stenosi esofagea
Spanish Constricción de esófago, Estrechez esofágica, Constricción esofágica, Estenosis esofágica, Constricción y estenosis de esófago, ESOFAGO, ESTENOSIS, estrechez y estenosis esofágica, SAI (trastorno), estenosis de esófago, estenosis esofágica (trastorno), esofagoestenosis, estenosis de esófago (trastorno), estenosis y estrechez esofágica (trastorno), estenosis y estrechez esofágica, estenosis esofágica, esofagoestenosis (trastorno), estrechez y estenosis esofágica, SAI, Estrangulación Esofágica, estrechez de esófago (trastorno), estrechez de esófago, estrechez esofágica, Estenosis de esófago, Estenosis Esofágica, Estrechamiento Esofágico
Swedish Matstrupsförträngning
Japanese ショクドウキョウサク, 食道狭窄, 食道狭窄症
Czech ezofágus - stenóza, ezofágus - striktura, Striktura jícnu, Stenóza jícnu, Striktura a stenóza jícnu
Finnish Ruokatorven ahtauma
Polish Zwężenie przełyku
Hungarian Oesophagus szűkülete, Nyelőcsőszűkület, Oesophagealis stenosis, Nyelőcső szűkület, Oesophagus stenosis, Nyelőcső szűkülete és stenosisa, Oesophagus strictura, Nyelőcső szűkülete, Oesophagus stenosisa
Norwegian Oesophagusstenose, Spiserørsstenose, Øsofagusstenose