Esophageal Stricture

What is an esophageal stricture?

The esophagus, the muscular tube that connects the throat and the stomach, is lined with a special mucosal tissue that lubricates food as it passes through. If the esophageal lining repeatedly becomes inflamed, scarring can result, which can cause a narrowing (stricture) of the tube. It may be difficult for food to pass through the stricture, and it may become impacted, or stuck, causing chest and abdominal pain. Most cases of esophageal stricture are caused by gastroesophageal reflux disease (GERD). In people with GERD the sphincter that closes to keep stomach contents from passing back up into the esophagus does not close properly. Repeated exposure to stomach acid can cause scarring on the esophageal lining. A esophageal strictures are more rarely causes by conditions in which webs or rings—thin layers of excess tissue—develop in the esophagus), cancer of the esophagus, scarring that develops after radiation therapy, or a disorder in the way the esophagus moves (a motility disorder).

What are the symptoms of an esophageal stricture?

• Pain while swallowing (odynophagia)
• Inability to swallow
• Sensation of food sticking in the throat or chest
• Drooling
• Regurgitation (bringing food back up)
• Frequent heartburn
• Food or stomach acid backs up into the throat
• Unexpected weight loss
• Coughing or gagging when swallowing
• Avoidance of certain foods that cause trouble swallowing

How are esophageal strictures diagnosed?

To diagnose an esophageal stricture doctors will probably perform two or more of the following tests:

• Esophagoscopy: In this test doctors use a camera called an esophagoscope to visualize the esophagus. This can be performed awake, in the doctor’s office, with a thin camera passed through the nose or under sedation, in an operative suite, with the camera passed through the mouth. In either case, the entire esophagus is visualized, allowing for evaluation for a possible stricture.
• Esophageal Manometry: An esophageal manometry measures the rhythmic muscle contractions, and the coordination and force exerted by the muscles, that occur in the esophagus when a person swallows. During this test, a thin, flexible tube (catheter) that contains sensors is passed through the nose, down the esophagus, and into the stomach. (The throat and nose are numbed for this test.) Patients will be asked to take small sips of water and swallow on command during the test.
• Modified Barium Swallow Study (MBS): During this test patients are asked to swallow a variety of substances that are coated with barium, a whitish paste that lights up during an X-ray, enabling the examiner to determine how well these substances are moving through the mouth, pharynx, and esophagus. The test will show if the upper esophageal sphincter is not relaxing or if foods or liquids are blocked as they pass through the esophagus.
• Flexible Endoscopic Evaluation of Swallowing (FEES): FEES is an instrumental examination of swallowing that allows the examiner to view food and liquid as it passes through the throat. Doctors pass a small flexible fiberoptic scope through the nose and hold it above the larynx to view the swallow.

How are esophageal strictures treated?

Treatment for an esophageal stricture depends on its causes and severity. Two important considerations in determining the best treatment for each patient are ensuring that he or she receives adequate nourishment and reducing his/her risk of pneumonia or other pulmonary infections. Treatment may include:

• Esophageal Dilation: In this procedure, the doctor uses an endoscope equipped with a dilating balloon or plastic dilator to stretch or dilate the esophagus. If the esophageal stricture is severe, doctors may dilate it gradually through repeated procedures.
• Medical management: If a stricture is related to gastroesophageal reflux disease (GERD), doctors will treat the condition with reflux medications.
• Feeding Tube: In most severe cases, a stricture can lead to an inability to eat or drink completely or not enough to maintain proper nutrition. In these cases, a feeding tube is placed.