9.8 : Esophageal Strictures-II: Clinical Features and Management

Patients with esophageal strictures often experience a range of symptoms. Initially, they may have difficulty swallowing solid foods, which can progress to include liquids. Additional symptoms may involve chest pain or discomfort, regurgitating food and fluids, heartburn, unintentional weight loss, coughing or choking during meals, and hoarseness.

Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is suspected, further diagnostic investigations are warranted. The primary diagnostic and therapeutic intervention is an upper GI endoscopy. It is crucial to biopsy any identified strictures to rule out malignancy.

A barium swallow involving chest X-rays may be necessary depending on the severity of dysphagia and clinical symptoms. This imaging test helps evaluate conditions like foreign body impaction, diaphragmatic hernia, and certain pulmonary conditions. It also provides insights into strictures' level, size, extent, and severity, which is particularly useful when standard endoscopes cannot pass the stricture.

Endoscopic ultrasound (EUS) can offer high-resolution images of the esophageal wall and detailed information on the extent of esophageal injury, especially in benign stricture causes.

Treatment Options for Esophageal Strictures:

1. Endoscopic Dilation: A common and effective method for managing benign strictures involves using a bougie or a balloon dilator to widen the narrowed esophagus. It may require periodic repetition.
2. Stent Placement: For malignant-related strictures, stents (metal or plastic tubes) can be placed to keep the narrowed area expanded.
3. Medical Management: Treating underlying causes like GERD with medications such as H2 blocker antagonists or proton pump inhibitors to reduce stomach acid.
4. Surgical Treatment: It is usually considered for severe or complicated cases, mainly when other treatments have been ineffective. It involves removing the narrowed esophageal portion and reconnecting the healthy parts.

Lifestyle Modifications:

1. Avoid spicy, fatty foods and caffeinated or carbonated beverages.
2. Abstain from alcohol and quit smoking.
3. Consume smaller meals and avoid eating close to bedtime.
4. Elevate the head end of the bed.
5. Maintain a healthy weight.

These strategies are crucial for managing GERD and preventing or delaying the development of esophageal strictures.