Understanding Esophageal Stricture

Introduction

Esophageal stricture, a term that may evoke concern or confusion, has a significant history in medical literature. Since ancient times, physicians have grappled with this challenging condition, seeking to understand its causes and develop effective treatments. The esophagus, a vital part of our digestive system, is susceptible to various disorders, and esophageal stricture is one such condition that continues to be of significant clinical importance. The purpose of this article is to provide clear, compassionate information to help you, the patient, understand esophageal stricture. We will discuss what it is, how it progresses, its prevalence, and the risk factors associated with its development. Esophageal stricture is a narrowing or tightening of the esophagus that causes swallowing difficulties.

Description of Esophageal Stricture

An esophageal stricture is a medical condition characterized by the abnormal narrowing of the esophagus. This may result from inflammation, injury, or other forms of damage. Over time, the stricture can lead to complications such as difficulty swallowing, regurgitation of food, and weight loss due to reduced food intake.

The progression of esophageal stricture is usually gradual. It often starts with minor discomfort during swallowing, progressing over months or years to more significant difficulties. It’s important to note that symptoms can sometimes remain stable for a long period before worsening.

Statistically, esophageal stricture affects a substantial number of people globally, although the exact prevalence can vary based on geographic location, lifestyle, and population characteristics. Estimates suggest that it affects roughly 1 in every 2,000 people, with higher incidences in older adults and those with certain medical conditions.

Risk Factors for Developing Esophageal Stricture

Lifestyle Risk Factors

Several lifestyle factors can contribute to the development of esophageal stricture. Regular consumption of hot or acidic foods and beverages can cause recurrent inflammation, increasing the risk of stricture. Similarly, alcohol and tobacco use have been linked to higher incidences of this condition. Furthermore, poor eating habits leading to obesity may indirectly increase the risk.

Medical Risk Factors

Medical conditions such as gastroesophageal reflux disease (GERD), where stomach acid regularly enters the esophagus, can cause chronic inflammation and scarring, leading to stricture. Esophageal cancer and certain surgical procedures on the esophagus may also lead to stricture. Additionally, certain infections or injuries can cause damage leading to esophageal stricture.

Genetic and Age-Related Risk Factors

Age is a significant risk factor for esophageal stricture, with older adults being more susceptible due to a lifetime of potential esophageal damage and reduced tissue resilience. Certain genetic disorders, such as epidermolysis bullosa, predispose individuals to esophageal stricture. Furthermore, research suggests a possible genetic component in susceptibility to conditions like GERD, which can lead to esophageal stricture.

Clinical Manifestations

When discussing esophageal stricture, it’s crucial to understand the clinical manifestations — the observable effects of the condition. These manifestations can vary in frequency and intensity based on the stage of the disease and the individual’s health status. Here, we outline the main clinical manifestations of esophageal stricture and their occurrence in affected individuals.

Difficulty Swallowing (Dysphagia)

Dysphagia is experienced by approximately 90% of esophageal stricture patients. This symptom is often more pronounced in later stages of the disease, as the esophagus becomes progressively narrower. Dysphagia refers to a feeling of difficulty or discomfort when swallowing, often described as food ‘sticking’ in the throat or chest.

Sensation of Food Getting Stuck in the Chest or Throat

This sensation, often coupled with dysphagia, is reported in about 80% of individuals with esophageal stricture. It’s typically a result of the narrowed esophagus struggling to allow the passage of food to the stomach, and may become more prevalent as the stricture worsens.

Pain or Discomfort While Swallowing (Odynophagia)

Odynophagia, or painful swallowing, occurs in around 70% of patients with esophageal stricture. This symptom may be due to the irritation and inflammation associated with the stricture, or the physical obstruction caused by the narrowed esophagus.

Regurgitation of Undigested Food or Liquids

Regurgitation is experienced by approximately 60% of patients with esophageal stricture. This occurs when food or liquid that has been swallowed is unable to pass through the stricture and is forced back up the esophagus.

Heartburn

Heartburn is reported by about 50% of esophageal stricture patients. The stricture can interfere with the esophagus’s natural process of moving food and liquid to the stomach, which can result in stomach acid refluxing back into the esophagus, causing a burning sensation.

Chest Pain

About 40% of individuals with esophageal stricture report experiencing chest pain. This can result from the strain of trying to swallow against the stricture, or from inflammation and irritation of the esophagus.

Weight Loss

Weight loss is a less common but still significant manifestation, occurring in around 30% of patients. This can result from reduced food intake due to difficulty swallowing, or from the regurgitation of food that cannot pass through the stricture.

Coughing or Choking While Eating

Coughing or choking while eating is reported by approximately 20% of individuals with esophageal stricture. This can occur when food or liquid is regurgitated into the throat or windpipe, triggering a coughing or choking reflex.

Gagging or Vomiting While Swallowing

Gagging or vomiting while swallowing is experienced by about 15% of patients. This may occur when the body reacts to the obstruction caused by the stricture.

Reflux Symptoms

Approximately 10% of patients with esophageal stricture experience symptoms of acid reflux. This can result from the stricture impeding the normal passage of food and liquid to the stomach, causing stomach acid to flow back into

the esophagus. This backflow, known as acid reflux, can cause symptoms such as heartburn and a sour taste in the mouth.

Diagnostic Evaluation

Diagnosing esophageal stricture involves a series of tests that help doctors confirm the presence of a stricture and assess its severity. The process typically starts with a review of your symptoms and medical history, followed by a physical examination. Here we discuss the common diagnostic tests and their relevance in diagnosing esophageal stricture.

Barium Swallow

A barium swallow, or esophagram, is a type of X-ray examination used to visualize the esophagus. You will be asked to swallow a liquid that contains barium, a substance that shows up clearly on X-rays. This test allows doctors to see the outline of your esophagus and identify any narrowing or other abnormalities. If the barium swallow shows a stricture, you may need further tests to determine the cause.

Results indicating esophageal stricture may include a noticeable narrowing of the esophagus or irregularities in its shape or contour. If the test is negative but symptoms persist, further investigation with other tests may be necessary.

Upper Endoscopy (EGD)

Upper endoscopy, also known as esophagogastroduodenoscopy (EGD), is a procedure where a flexible tube with a light and camera at the end (endoscope) is inserted through the mouth to visualize the esophagus, stomach, and first part of the small intestine. This test allows for direct visualization of any strictures and can also be used to take biopsies if needed.

Strictures may appear as a narrowed section of the esophagus with smooth walls. If the endoscopy is negative but symptoms persist, additional tests may be recommended to rule out other conditions.

Biopsy

A biopsy involves taking a small sample of tissue from the esophagus for examination under a microscope. This is usually done during an endoscopy. A biopsy can help determine the cause of the stricture, such as inflammation, infection, or cancer.

Abnormal cells or evidence of inflammation in the biopsy sample can indicate a stricture. If the biopsy is negative but symptoms persist, your doctor may suggest further tests or a review of your symptoms and history.

Esophageal Manometry

Esophageal manometry measures the pressure and coordination of muscle contractions in your esophagus when you swallow. A thin, flexible tube is passed through your nose, down your esophagus, and into your stomach. This test can help determine if your symptoms are due to a problem with the function of your esophagus.

Results indicating esophageal stricture may include low pressures or uncoordinated contractions in the area of the stricture. If the manometry is negative but symptoms persist, your doctor may recommend additional tests.

Esophageal pH Monitoring

Esophageal pH monitoring measures the amount of acid in your esophagus over a 24-hour period. A small device is inserted into your esophagus to measure acid levels. This test can help determine if acid reflux is causing your symptoms and contributing to a stricture.

Results indicating esophageal stricture may include an increased amount of acid in the lower esophagus, suggesting acid reflux. If the pH monitoring is negative but symptoms persist, further investigation may be required.

What if all Tests are Negative but Symptoms Persist?

If all tests return negative results, but you continue to experience symptoms, it’s essential to communicate this to your healthcare provider. There may be other conditions causing your symptoms, or further testing may be required. Your healthcare provider will work with you to determine the next steps, which may include a review of your symptoms and medical history, additional tests, or a referral to a specialist. Remember, it’s important to advocate for your health and seek care until you have a clear understanding of your symptoms.

Health Conditions with Similar Symptoms to Esophageal stricture

It’s important to note that the symptoms of esophageal stricture can resemble those of other health conditions. Here are some conditions with similar manifestations, their definitions, and how to differentiate them from esophageal stricture.

Gastroesophageal reflux disease (GERD)

Gastroesophageal reflux disease, or GERD, is a chronic condition where stomach acid frequently flows back into the esophagus, irritating the lining and causing symptoms like heartburn and acid reflux.

GERD shares several symptoms with esophageal stricture, including heartburn, regurgitation, and difficulty swallowing. However, GERD also often presents with a chronic cough, sore throat, and a sensation of a lump in the throat – symptoms not typically associated with esophageal stricture. To differentiate GERD from esophageal stricture, doctors may use tests like esophageal pH monitoring to measure acid levels in the esophagus. High levels of acid may suggest GERD, whereas a stricture might show up on a barium swallow or endoscopy.

Eosinophilic esophagitis

Eosinophilic esophagitis (EoE) is a chronic immune system disease in which a type of white blood cell, the eosinophil, builds up in the esophagus, leading to inflammation and difficulty swallowing.

EoE and esophageal stricture both cause dysphagia, or difficulty swallowing, and food getting stuck in the esophagus. However, EoE may also cause persistent heartburn that doesn’t respond to usual GERD medications, chest pain not related to eating, and in children, failure to thrive. EoE is usually diagnosed by an endoscopy and biopsy, which would show high numbers of eosinophils in the esophagus, whereas esophageal stricture would show a narrowed esophagus without significant eosinophilic infiltration.

Achalasia

Achalasia is a rare disorder that impairs the esophagus’s ability to move food into the stomach. This happens when the lower esophageal sphincter, a muscular ring at the end of the esophagus, doesn’t relax properly.

Achalasia can mimic esophageal stricture in that both conditions can cause dysphagia and regurgitation. However, achalasia may also cause rapid weight loss and night-time coughing or aspiration that isn’t common in esophageal stricture. Esophageal manometry, a test that measures muscle contractions in the esophagus, can help differentiate the two conditions. In achalasia, the test will show abnormal contractions and failure of the lower esophageal sphincter to relax, while in esophageal stricture, the test may show normal muscle function but physical narrowing of the esophagus.

Esophageal Cancer

Esophageal cancer is a disease where malignant cells form in the tissues of the esophagus. There are two main types: squamous cell carcinoma and adenocarcinoma.

Esophageal cancer and esophageal stricture share symptoms such as difficulty swallowing and weight loss. However, esophageal cancer may also present with hoarseness, persistent cough, or vomiting, which are less common in esophageal stricture. Both conditions can be visualized on an endoscopy, but a biopsy will differentiate between them. In esophageal cancer, the biopsy will show cancerous cells, while in esophageal stricture, it would show normal cells but a narrowed esophagus.

Schatzki ring: This is a narrow ring of tissue located just above the junction of the esophagus and stomach. It can cause difficulty swallowing, similar to esophageal stricture. An upper endoscopy or barium swallow can show the presence of the ring, differentiating it from an esophageal stricture.

Hiatal hernia: This condition occurs when a part of the stomach bulges up through the diaphragm into the chest. It can cause heartburn and regurgitation, similar to esophageal stricture. However, symptoms like fullness or pain after eating, or feeling short of breath, are more unique to hiatal hernia. A barium swallow or endoscopy can confirm the diagnosis.

Plummer-Vinson syndrome: This is a rare condition characterized by difficulty swallowing, iron-deficiency anemia, and esophageal webs (thin pieces of tissue that partially block the esophagus). While difficulty swallowing is common to both conditions, the presence of anemia and the discovery of webs during an endoscopy would suggest Plummer-Vinson syndrome.

Foreign body impaction: This occurs when a foreign object is lodged in the esophagus. It can cause sudden onset of dysphagia, unlike the gradual onset typical of esophageal stricture. An X-ray or endoscopy can confirm the presence of a foreign body.

Neuromuscular disorders affecting swallowing: Certain neuromuscular conditions can affect the nerves and muscles involved in swallowing, leading to dysphagia. However, these conditions also typically involve other neurological symptoms, such as muscle weakness or sensory changes. Diagnosis would involve neurological examination and tests.

Peptic ulcer disease: This condition involves sores in the lining of the stomach or first part of the small intestine. It can cause symptoms like heartburn and regurgitation, similar to esophageal stricture. However, symptoms like stomach pain that improves with eating are more unique to peptic ulcer disease. An endoscopy or barium swallow can differentiate the two conditions.

Treatment Options

Esophageal stricture management aims to relieve symptoms, prevent complications, and improve quality of life. Here are the commonly used medications and procedures:

Medications

• Proton pump inhibitors (PPIs): These are medications that reduce the production of stomach acid. By doing so, they can help heal esophageal damage and prevent further injury that could lead to strictures. They are often used first-line in treating esophageal strictures caused by acid reflux.
• Corticosteroids: These are anti-inflammatory medications that can reduce swelling and inflammation in the esophagus. They might be used in cases where the stricture is caused by inflammatory conditions such as eosinophilic esophagitis.
• Topical anesthetics: These medications can be used to numb the esophagus and relieve pain during swallowing.
• Antacids: These medications neutralize stomach acid and can provide quick relief from heartburn, a common symptom of esophageal stricture.
• Acid suppressors: Also known as H2 blockers, these medications reduce the amount of acid the stomach makes. Like PPIs, they can help heal and prevent further damage to the esophagus.
• Pain relievers: Over-the-counter or prescription pain medications may be used to manage pain associated with esophageal stricture.
• Prokinetics: These medications help improve the movement of food through the esophagus and are used in cases where poor esophageal motility contributes to the stricture.
• Antibiotics (if infection is present): If the esophageal stricture is associated with an infection, antibiotics may be prescribed to treat the underlying infection.
• Antifungal agents (if fungal infection is present): If the stricture is associated with a fungal infection, antifungal agents may be prescribed.
• Immunosuppressants: These medications reduce the body’s immune response and may be used in strictures caused by immune-related conditions.

Procedures

• Dilation (balloon or bougie): This is a common procedure for treating esophageal strictures. It involves inserting a thin tube with a balloon or bougie (a thin, flexible medical-grade dilator) into the esophagus to gently stretch and widen the stricture.
• Esophageal stent placement: This procedure involves inserting a stent (a tube made of metal or plastic) into the esophagus to keep it open. This is typically used for more severe strictures or those that don’t respond to dilation.
• Endoscopic incisional therapy: This procedure involves making small cuts in the stricture to help widen the esophagus. It’s typically used for strictures that don’t respond to other treatments.
• Steroid injection: This involves injecting steroids directly into the stricture during an endoscopy to reduce inflammation and help the stricture heal.
• Laser therapy: This uses a laser to cut through and remove the stricture. It’s typically reserved for severe or recurrent strictures.
• Surgical intervention (esophageal reconstruction): In severe cases where other treatments have failed, surgery may be required to reconstruct the esophagus.
• Esophageal bypass surgery: This is a major surgical procedure that involves creating a new pathway for food to reach the stomach, bypassing the narrowed part of the esophagus.
• Cricopharyngeal myotomy: This surgical procedure involves cutting the upper esophageal sphincter muscle to allow easier passage of food and liquid into the esophagus.
• Endoscopic mucosal resection (EMR): This procedure is used to remove abnormal or cancerous tissue from the esophagus.
• Endoscopic submucosal dissection (ESD): This is a more advanced endoscopic procedure used to remove deeper, larger areas of abnormal or cancerous tissue from the esophagus.

Each of these treatments has its benefits and risks. Your healthcare provider will discuss these with you and help you decide the best treatment option based on your specific condition, symptoms, and overall health.

Improving Esophageal Stricture and Seeking Medical Help

Esophageal stricture can significantly impact your daily life, but there are several strategies you can adopt at home to manage your symptoms and improve your quality of life:

• Dietary changes: Soft or pureed foods can pass through the esophagus more easily. This can help reduce the discomfort associated with swallowing.
• Chewing food thoroughly: Smaller food particles can pass through a narrow esophagus more readily.
• Eating smaller, more frequent meals: This can prevent overloading the esophagus and reduce symptoms.
• Drinking plenty of fluids with meals: This can help facilitate the passage of food through the esophagus.
• Avoiding large bites and fast eating: Larger pieces of food and rapid eating can exacerbate symptoms.
• Avoiding foods that trigger symptoms: Certain foods may cause or worsen heartburn and other symptoms. Identifying and avoiding these can help manage symptoms.
• Maintaining an upright position while eating: Gravity can assist in moving food down the esophagus.
• Weight management: Overweight and obesity can increase pressure on the abdomen and worsen symptoms.
• Smoking cessation: Smoking can irritate the esophagus and exacerbate symptoms.
• Stress management techniques: Stress can worsen many health conditions, including esophageal stricture. Techniques such as yoga, meditation, and deep breathing can help manage stress levels.

Remember, while these strategies can help manage symptoms, they are not a substitute for medical treatment. If you notice your symptoms persist or worsen despite these efforts, it’s essential to seek medical help promptly. Utilizing telemedicine services, like our primary care practice, can be an efficient and convenient way to receive professional medical advice.

Living with Esophageal Stricture: Tips for Better Quality of Life

Esophageal stricture is a chronic condition that can be managed effectively with the right care, medication, and lifestyle adaptations. Regular follow-ups with your healthcare provider, adherence to prescribed medications, and a healthy lifestyle can significantly improve your quality of life.

Conclusion

Esophageal stricture is a condition characterized by a narrowing of the esophagus that can lead to difficulty swallowing and other symptoms. Early diagnosis and treatment are crucial for preventing complications and improving the quality of life. At our primary care practice, we provide comprehensive telemedicine services, allowing you to receive expert care from the comfort of your own home. We’re here to support you every step of the way as you navigate your health journey with esophageal stricture.

Brief Legal Disclaimer: This article is for informational purposes only and not intended as medical advice. Always consult a healthcare professional for diagnosis and treatment. Reliance on the information provided here is at your own risk.