One of the main causes of esophageal stricture formation is caustic ingestion. Patients may become symptomatic several weeks after ingestion.
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 can cause structural damage to the esophagus. Repair of this damage can lead to fibrosis with subsequent formation of esophageal strictures.
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."
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.
Chronic dysphagia can lead to patients consuming less food. As a result, weight loss can occur in these patients.
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.
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.
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 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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