Master Esophageal Stricture with Picmonic for Medicine

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Esophageal Stricture

Sarcophagus with Stricture
CristianCazac
An esophageal stricture is a narrowing of the esophageal lumen. This narrowing can prevent the passage of food. Risk factors include caustic ingestion, gastroesophageal reflux disease, esophagitis, and Schatzki rings. Symptoms include dysphagia and weight loss. This disease can be diagnosed with the help of barium swallow or endoscopy. Management strategies include esophageal dilation and proton pump inhibitors.
10 KEY FACTS
RISK FACTORS
Caustic Ingestion
Caustic Soda Ingestion

One of the main causes of esophageal stricture formation is caustic ingestion. Patients may become symptomatic several weeks after ingestion.

Gastroesophageal Reflux Disease
Girdle-girl

GERD causes gastric acid to reflux into the esophagus. The chronic reflux causes repetitive damage to the lower esophagus and can lead to fibrosis and stricture formation.

Esophagitis
Sarcophagus-on-fire

Esophagitis can cause structural damage to the esophagus. Repair of this damage can lead to fibrosis with subsequent formation of esophageal strictures.

Schatzki Rings
Shots-ski with Rings

Schatzki rings are a distal narrowing of the esophagus and are one of the most common causes of esophageal food impaction. The impaction typically presents after ingestion of meats, earning them the nickname of "steakhouse syndrome."

CLINICAL FEATURES
Dysphagia
Dice-fajita

Esophageal strictures prevent the passage of solid foods through the esophagus causing dysphagia. In obstructive esophageal disorders, dysphagia to solids, but not to liquids, is seen. Contrast this with motility disorders, such as diffuse esophageal spasm, in which dysphagia to both solids and liquids is observed.

Weight Loss
Skinny with Baggy-Pants

Chronic dysphagia can lead to patients consuming less food. As a result, weight loss can occur in these patients.

DIAGNOSIS
Barium Swallow
Swallowing Berries

The best initial test in evaluating a stricture is a barium swallow. The typical findings on barium swallow is a narrowing of the esophageal lumen.

Endoscopy
Endoscope

Since a barium swallow is not reliable in differentiating malignant versus benign strictures, an endoscopy is typically conducted after a barium swallow to further investigate the stricture.

MANAGEMENT
Esophageal Dilation
Dyed-dilated Sarcophagus

Esophageal dilation can be used to relieve the symptoms of a esophageal stricture. However, since esophageal strictures are typically the result of other disease processes, treating the underlying cause of the stricture is important as well.

Proton Pump Inhibitors
Proton Pump with Inhibiting-chains

Proton pump inhibitors can be used to reduce gastric acid secretion. This subsequently reduces the damage that acid reflux causes to the lower esophagus. Proton pump inhibitors are also used in the management of GERD.

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