//fpnotebook.com/
Esophageal Stricture
Aka: Esophageal Stricture
- Definitions
- Esophageal Stricture
- Abnormal narrowing of the esophageal lumen
- Epidemiology
- Incidence: 1.1 per 10,000
- Ten times more common in white patients than black or asian patients
- Pathophysiology
- Narrowing in the esophageal lumen due to inflammation, neoplasm, fibrosis or injury
- Dysphagia occurs when esophagus narrows to <13 mm from normal 20 mm size in adults
- Risk Factors
- Gastroesophageal Reflux Disease
- Hiatal Hernia
- Peptic Ulcer Disease
- Alcohol Use
- Dysphagia past medical history
- Causes
- Neoplasm (e.g. Esophageal Cancer)
- Gastroesophageal Reflux (GERD)
- Benign peptic strictures form with longstanding GERD
- Responsible for up to 70% of Esophageal Strictures in adults
- Injury
- Post-procedural Esophageal Stricture (e.g. upper endoscopy)
- Ingested hot or toxic liquid or solid (e.g. corrosive liquid ingestion in children)
- Radiation Therapy (cervical and thoracic regions)
- Prolonged Nasogastric Tube or Orogastric Tube
- Eosinophilic Esophagitis
- Higher risk of stricture with prolonged untreated disease
- Pill Esophagitis (e.g. NSAIDs, Doxycycline)
- Prolonged use of causative medications
- Viral Infections (esp. immunocompromised)
- Cytomegalovirus (CMV)
- Herpes Simplex Virus (HSV)
- Human Immunodeficiency Virus (HIV)
- Esophageal Candidiasis
- Miscellaneous
- Collagen Vascular Disease
- Esophageal Ring or Esophageal Web
- Crohn Disease
- Tuberculosis
- Symptoms
- Solid food Dysphagia (may progress to liquid Dysphagia)
- Food impaction
- Odynophagia
- Chest Pain
- Weight loss
- Differential Diagnosis
- See Esophageal Dysphagia
- External esophageal compression (e.g. thoracic mass)
- Esophageal Spasm
- Achalasia
- Esophageal Cancer
- Diagnosis
- Upper Endoscopy (EGD) is preferred
- Allows for direct visualization and biopsy
- Endoscopic Ultrasound may be performed to evaluate lesion depth
- Barium swallow
- May be considered when upper endoscopy is not readily available
- Test Sensitivity: 95% for Esophageal Stricture
- Other imaging
- Chest XRay or CT Chest
- Consider for excluding alternative diagnoses (e.g. external compression)
- Grading: Dysphagia Scoring System
- Score 0: No Dysphagia
- Score 1: Moderate passage - able to eat some solid food
- Score 2: Poor passage - able to eat only semi-solid food
- Score 3: Very poor passage - able to swallow only liquids
- Score 4: No passage - unable to swallow anything
- Management
- First-line measures
- Esophageal Dilation (push/bougie or balloon)
- Intralesional Corticosteroid (adjunctive to dilation, refractory cases)
- Refractory case measures
- Esophageal Stent such as self-expanding metal stent or SEMS (esp. in malignancy)
- Surgical resection (esp. in malignancy)
- Maintenance management
- Proton Pump Inhibitor (PPI, e.g. Omeprazole) longterm use
- Complications
- Food Impaction
- Aspiration
- Esophageal Perforation
- Esophageal fistula
- References
- Moustarah (2020) StatPearls, accessed 9/24/20
- Pasha (2014) Gastrointest Endosc 79(2): 191-201 [PubMed]