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Esophageal Stricture (ES)

Esophageal Stricture (ES): Causes, Symptoms, Diagnosis, and Management

An Esophageal Stricture (ES) is a narrowing of the esophagus due to scarring, inflammation, or tumors, impairing swallowing. Below is a synthesis of its key aspects, supported by clinical guidelines and research.

Causes

1. Chronic Inflammation:
   • GERD: Acid reflux damages the esophageal lining, leading to scarring and narrowing245.
   • Eosinophilic esophagitis: Allergic inflammation from food or environmental triggers34.
2. Trauma:
   • Endoscopy injury, nasogastric tube use, or swallowing corrosive substances (e.g., household cleaners)35.
3. Medications:
   • NSAIDs, antibiotics, or chemotherapy (e.g., radiation therapy)13.
4. Other Conditions:
   • Esophageal varices treatment, hiatal hernia, or scleroderma45.
5. Malignancy:
   • Esophageal cancer: Rapidly progressive strictures compared to benign causes23.

Symptoms

Common Symptoms	Severe/Complications
Dysphagia: Difficulty swallowing solids/liquids.	Food impaction: Pain, vomiting, or choking7.
Regurgitation of food.	Aspiration pneumonia (food/liquid entering lungs)5.
Weight loss, fatigue.	Malnutrition/dehydration (chronic cases)15.
Chest pain or burning.	Stricture recurrence after treatment5.

Red flags: Sudden dysphagia or rapid symptom progression may indicate cancer23.

Diagnosis

1. Endoscopy:
   • Visual inspection: Identifies narrowing, inflammation, or tumors.
   • Biopsy: Rules out cancer or eosinophilic esophagitis245.
2. Barium Swallow:
   • Esophagram: X-rays with contrast highlight strictures45.
3. CT Scan:
   • Cross-sectional imaging: Assesses extrinsic compression (e.g., tumors)4.

Treatment

1. Dilation:
   • Balloon dilation: Stretching the stricture via endoscopy; repeated as needed56.
   • Stents: Temporary placement for severe strictures6.
2. Medications:
   • Proton pump inhibitors (PPIs): Reduce acid reflux to prevent recurrence56.
   • Steroids: For eosinophilic esophagitis (e.g., swallowed fluticasone)35.
3. Surgery:
   • Esophagectomy: Reserved for refractory strictures or cancer25.

Complications

• Malnutrition: Inadequate nutrient intake due to dysphagia15.
• Aspiration pneumonia: Risk from regurgitation5.
• Stricture recurrence: Common without GERD management5.

Prognosis

• Benign strictures: Manageable with dilation and PPIs; recurrence is frequent56.
• Malignant strictures: Poor prognosis if untreated; early detection improves survival23.

Conclusion
Esophageal strictures are treatable but require prompt evaluation to address underlying causes (e.g., GERD, cancer). Dilation and acid suppression are cornerstones of therapy.

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References

1. WebMD: Esophageal Stricture
2. Cleveland Clinic: Esophageal Strictures
3. Aurora Health Care: Esophageal Stricture
4. Northwestern Medicine: Esophageal Stricture
5. MedlinePlus: Benign Esophageal Stricture
6. UCLA Health: Esophageal Stricture
7. Columbia Doctors: Esophageal Stricture
8. Healthline: Benign Esophageal Stricture