Esophageal Strictures - Understanding Esophageal Narrowing

Introduction:

An esophageal stricture is the constriction or narrowing of the esophagus. It is often a sequela to many different conditions. The esophagus serves as a muscular conduit linking the throat to the stomach. It is approximately eight inches long and is lined by a tissue called the mucosa. The esophagus passes through the diaphragm (major muscle of respiration) just before entering the stomach. The function of the esophagus is to carry food and liquid to the stomach. Any tightening of the esophagus will lead to difficulty in eating and drinking. Individuals who have cancer in the neck area, engage in excessive alcohol consumption, and suffer from gastroesophageal reflux disease, or peptic ulcer disease have an increased likelihood of developing esophageal strictures. The esophageal strictures diagnosis and treatment should be prompt.

What Is Esophageal Stricture?

An esophageal stricture is an abnormal narrowing or tightening in some portion of the esophagus. It makes it difficult for people to swallow the food, and in severe cases, even drinking fluids get difficult. Esophageal strictures can be cancerous (malignant) that get worse quickly or noncancerous (benign), which tend to progress slowly. The presence of it can either be concentrated in specific areas or spread along the entire length of the esophagus. Esophageal strictures are not very common. Though they can affect people of all age groups, they usually occur in people above 40 years of age.

What Are the Types of Esophageal Strictures?

There are two common types of esophageal strictures:

1. Simple Strictures - These are smaller and have a wider opening of the esophagus. They are often symmetrical and straight and also have smooth surfaces and margins.

2. Complex Strictures - These are longer and have a narrow opening of the esophagus. They have uneven borders and surfaces and are not symmetrical or straight.

What Are the Signs and Symptoms of Esophageal Stricture?

• Burning sensation in the throat.

• Dysphagia (difficulty swallowing).

• Felt as if food got stuck in the throat.

• Repeated episodes of choking.

What Are the Causes of Esophageal Stricture?

Inflammation and scarring in the esophagus can cause esophageal strictures. The conditions or treatments that can lead to esophageal strictures are:

• Esophageal Cancer - Abnormal growth of cells in the esophageal tissue leads to tumor formation, which in turn leads to esophageal strictures.

• Esophageal Esophagitis - It is an allergic reaction that causes inflammation in the esophagus and later esophageal strictures.

• Gastroesophageal Reflux Disease (GERD) - In this condition, the stomach acid can flow backward and damage the lining of the esophagus. The constriction of the esophagus because of this condition is often known as a peptic stricture.

• Surgery - A surgical procedure in the esophagus can cause esophageal stricture because of inflammation and scarring.

• Radiation Therapy - When radiation therapy is used as the treatment mode for cancer of the head, neck, or chest region, it can cause esophageal strictures for up to a year and a half later.

• Others - The other causes of esophageal strictures include ulcers, medications such as antibiotics and non-steroidal anti-inflammatory drugs, accidentally swallowing chemicals, and certain infections.

How to Diagnose Esophageal Strictures?

The following tests are recommended by the doctor to confirm the diagnosis of esophageal stricture:

• Ultrasound - In this, sound waves are used to create detailed images of the region affected. These images help in measuring the thickness of the esophageal wall, which indicates how much it is narrowing.

• X-ray With Barium - The patient is asked to swallow a solution containing barium. After that, the healthcare provider will take x-rays of the neck and chest region. The barium that travels down the esophagus highlights the problems present for the provider to see it on the X-rays.

• Upper Gastrointestinal Endoscopy - The patient's mouth is entered by inserting an endoscope, which is a slender, flexible tube equipped with a camera and light at its tip. This is done to examine the esophagus, and if needed, a small piece of tissue is taken for biopsy.

• Esophageal Manometry - This test is done to examine the esophageal muscles and sphincter. A slender tube known as a catheter is placed through the nostril to access the esophagus. It measures the valve and muscle function of the esophagus during swallowing.

What Are the Treatment Options for Esophageal Strictures?

• The treatment of the esophageal strictures depends on the cause of the narrowing. For chronic gastroesophageal reflux disease, changes in eating habits or medications to reduce the amount of acid in the stomach can be beneficial. When the tumor is the cause, the treatment plan includes surgery.

• The most common treatment for strictures is esophageal dilation. In this procedure, a dilator (a long rubber or plastic cylinder) or balloon is used to widen the narrow part of the esophagus. The balloon or dilator is inserted into the esophagus using an endoscope.

• Before the procedure, patients are given sedatives that help them relax and reduce pain, and also the throat is numbed. Patients with complex strictures may need metal esophageal stents to prop open strictures.

• Esophageal dilation is an outpatient procedure. Once the impact of the medications subsides, the patient is permitted to return home. The patient is advised to avoid eating, drinking, driving, or working for a period of time. They are given medicines to control acid at home.

• Many patients require more than one dilation over time to have a wide enough esophagus for the food to pass. The doctor repeats the dilation procedure to stop the esophagus from narrowing or tightening again.

• Sometimes, untreated and severe esophageal strictures can cause perforations. This can be life-threatening. It is crucial to seek medical attention promptly upon experiencing symptoms, which is why it is important.

How Can Esophageal Strictures Be Prevented?

Gastroesophageal reflux disease is the most common cause of esophageal strictures. Certain dietary and lifestyle changes can help to control reflux and delay or prevent strictures.

• Avoid drinking alcohol.

• Stop smoking.

• Avoid fatty, spicy, and citrusy foods and caffeinated or carbonated beverages.

• Avoid eating immediately before bedtime.

• Have smaller meals.

• Elevate the headrest or pillow while resting or sleeping.

• Always maintain a healthy weight.

Conclusion:

Esophageal stricture refers to the constriction of the esophagus. If any individual feels the symptoms of stricture, they should immediately see a doctor. The degree of narrowing in the esophagus will be assessed by the doctor, and the treatment plan will be determined based on that evaluation. Patients with strictures are often recommended lifestyle changes and healthy choices.