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What is Esophageal Stricture?

Esophageal stricture is a tapering and tightening of the esophagus that makes swallowing difficult. The esophagus is a tube-like membrane that runs between the throat and stomach. Its function is to transport food and fluids from the mouth to the stomach. The esophagus also acts as a vent for the stomach, releasing air to prevent abdominal bloating.

Many conditions can lead to esophageal strictures, such as a hiatal hernia, gastroesophageal reflux disease, or esophagitis. Treatments for this condition vary depending on the severity of each case. In most cases, an esophageal stricture is a non-cancerous condition. However, some cases are cancer-related.

Read below to find out what causes esophageal strictures, possible treatment options, and more.

Discovering esophageal stricture causes

Several conditions can trigger esophageal narrowing. The leading cause of esophageal stricture is acid reflux. In this condition, acid bubbles up from the stomach and travels into the esophagus. Over time, acid reflux can lead to swelling or scarring of the esophageal walls. Scar formations result in a concentric ring (Schatzki’s ring) that blocks the opening of the esophagus.

Congenital and benign strictures

Congenital conditions may result in benign esophageal stricture, such as a membranous diaphragm. The membranous diaphragm is a web-like formation that causes a thickening of the esophageal walls.  It can occur anywhere in the esophagus but is typically found in the upper portion. Benign strictures can also be the result of ingesting harmful substances, radiation treatments, or post-surgical injury.

Cancer

Most cases of esophageal stricture do not involve cancer. However, every year around 11,000 new cases of esophageal cancer occur. Esophageal cancer primarily develops in the lower portion of the esophagus. This form of cancer is called Barrett’s Esophagus. It is related to excessive use of alcohol or smoking, especially during the patient’s young adult years.

Risk factors for esophageal stricture

Risk factors are things that increase your chances of getting a condition. Having risk factors does not mean you will get esophageal stricture. However, these characteristics are common in people who have an esophageal stricture. Although many risk factors are avoidable, others are not.

Avoidable risk factors

You can reduce your chances of developing an esophageal stricture by changing your habits.

  • Alcohol or tobacco use – Tobacco products puts you at a higher risk of benign stricture, and esophageal cancer. Drinking alcohol also increases the risk of acquiring this condition.
  • Some forms of obesity – People who are overweight are often at higher risk of experiencing acid reflux, which can lead to esophageal problems.
  • Dietary habits – Individuals who have a diet high in acidic foods are at greater risk of esophageal damage due to acid reflux. Drinking hot liquids can also destroy the lining of the esophagus, which also increases the risk of this condition.
  • Chemical exposure – Chemical exposure can happen just about anywhere, including at home or in the workplace. Inhaling or drinking chemicals can damage the esophageal walls. These substances can raise the risk of both benign and malignant esophageal strictures.

Unavoidable risk factors

Some risk factors involve age, gender, and other health conditions. You may not have much control over these factors. However, just because they are present does not mean you will develop the condition.

  • Age and sex – Men, ages 55 or older are three times more likely to get esophageal stricture, than women, or people who are younger.
  • Certain health conditions – Gastroesophageal reflux disease (GERD), Barrett’s esophagus, Achalasia, Tylosis, Plummer-Vinson syndrome, and Human Papillomavirus (HPV) increase the risk of esophageal stricture.

Evaluating esophageal stricture symptoms

There are several symptoms that may indicate a narrowing of the esophagus. You may have difficulty swallowing or choke easily on food or drinks. A bitter taste in your mouth and frequent burping or hiccupping is also a sign of esophageal stricture. You may lose weight without trying, and your chest may feel heavy or tight.

Diagnosing esophageal stricture

There are a variety of assessments your doctor may perform to diagnose esophageal stricture.

Barium swallow

One diagnostic procedure is a barium swallow, which is also called a barium esophagogram. It requires patients to swallow a barium solution. As the solution travels down the esophagus, a technician takes several x-ray images. If the condition is present, the increased contrast from the barium will help the stricture show up on the x-ray.

Endoscope

If a structure abnormality suspected, an endoscopy can be performed. An endoscope is a thin tube with a small camera and light at one end that helps doctors to see inside the esophagus. The patient is under sedation and does not feel pain. The doctor can also take a biopsy with the scope or stretch narrow areas if necessary.

Esophageal manometry

Esophageal manometry is another diagnostic procedure. It is often used when the endoscopy does not reveal abnormalities. It is a test that measures how often the esophageal sphincter opens and shuts. If the esophagus has a high number of contractions, it could indicate an esophageal stricture.

Esophageal motility

An esophageal motility is a test that measures the strength and elasticity of the esophageal muscles. This test is performed by running a tiny tube through the nostrils and into the esophagus. Transducers attached to the tube help detect abnormalities of the lower esophageal opening.

Finding an esophageal stricture treatment

Several methods that may be used for treatment, depending on the severity of the stricture.

  • Esophageal dilation – A surgeon will insert an endoscope down your throat and into your esophagus. Then a small balloon is inflated at the end of the endoscope to stretch the esophageal walls.
  • Esophageal stent placement – Stents are thin tubes made of plastic, flexible metal or mesh materials. Esophageal stents hold open the esophagus, making it easier to swallow food and liquids.
  • Drug treatment therapy – Proton pump inhibitors (PPIs) are a class of acid-blocking drugs that is often used for the treatment of GERDs. PPI drug treatment may include omeprazole, pantoprazole, lansoprazole, esomeprazole, antacids, antihistamines or sucralfate.

Esophageal stricture prognosis

Esophageal strictures are correctable with treatment. However, a small number of patients may require future dilation. Many patients must remain on acid reflux medication to help prevent the stricture from reoccurring.

Dietary and lifestyle choices for a healthy esophagus

Making the right dietary and lifestyle changes can help reduce your chances of esophageal strictures reoccurring.

Use these tips to keep your esophagus healthy.

  • Elevate your pillow to prevent stomach acid from traveling into the esophagus
  • Eat dinner at least three hours prior to bedtime
  • Maintain a healthy weight by exercising regularly
  • Do not smoke or consume alcoholic beverages
  • Avoid spicy or fatty foods, carbonated beverages, coffee and caffeine, citrus products, tomatoes, and chocolate

When to seek medical attention

Contact your current doctor if you have a fever, cannot swallow, and frequent vomiting. These symptoms could be signs of a severe esophageal structure. You should also contact a medical professional if your symptoms get worse or you continue having pain after taking medication.

Get immediate medical attention if you have black or bloody bowel movements, or vomit that contains blood or a gritty substance that looks like coffee grounds.

Esophageal structure prevention

To prevent esophageal structure, avoid drinking, eating, or breathing substances that can injure your esophagus.

Handling symptoms of GERD properly can also reduce your risk for esophageal stricture. Follow instructions about dietary and lifestyle choices to avoid acid buildup in your esophagus. Take all medications as prescribed to control esophageal structure symptoms.

Although an esophageal stricture can cause discomfort or other health issues, it is usually easy to diagnose and treat. Follow dietary guidelines and maintain a healthy weight to prevent a reoccurrence of these symptoms.

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