Benign (noncancerous) esophageal stricture is a condition in which the diameter of the esophagus is made narrow by scar tissue. The esophagus is the tube that brings food and liquids from your mouth to your stomach.
Even though the condition is not cancerous, it can still cause serious health issues. Narrowing of the esophagus can cause swallowing difficulty and also increases choking risk.
Benign esophageal stricture can be caused by damage to the esophagus that results in the formation of scar tissue. The most common cause of this condition is chronic heartburn, known as gastroesophageal reflux disease (GERD), which causes corrosive stomach acid to flow back up into the esophagus, creating a burning sensation in the lower chest. Frequent exposure to harmful stomach acid can cause scar tissue and a subsequent narrowing of the esophagus.
GERD affects about 40 percent of all adults, and esophageal strictures occur in 7 to 23 percent of untreated GERD patients (Mukherjee, et al., 2012).
Other causes of the condition include:
- extended use of a nasogastric tube (a tube inserted through the nose, into the esophagus and the stomach)
- ingestion of an acidic or corrosive substance, such as batteries or household cleaners
- damage caused by an endoscope (a thin, lighted tube used to see images inside the body for evaluation)
- treatment of esophageal varices (enlarged veins in the esophagus that can bleed and require repair, often with an endoscope)
- radiation therapy to the chest or neck
If you have experienced esophageal scarring, you are at an increased risk for benign esophageal stricture. GERD is the most common cause of scarring. Having GERD increases your risk of developing stricture.
Typical symptoms include:
- dysphagia: difficulty swallowing or feeling that food is not passing into the stomach normally
- painful swallowing
- unintended weight loss
- regurgitation of food or liquids: substances from the stomach flow back into the esophagus or up into the mouth
Problems with swallowing can prevent you from getting the right amount of food and fluids necessary for good nutrition, which may lead to dehydration and malnutrition.
With the narrowing of the esophagus, denser solid foods, such as meat, can become lodged in the esophagus above the stricture, causing you to choke or have trouble breathing.
Regurgitating foods and liquids can result in pulmonary aspiration, which occurs when foods, fluids, or vomit enter your lungs. This could result in choking or aspiration pneumonia, a condition where the lungs and the airways leading into the lungs become inflamed.
Your physician can diagnose this condition with one of the following tests:
Barium Swallow Test
In this test, a series of X-rays of the esophagus are taken during and after drinking a barium contrast material. This contrast material is a liquid that will temporarily coat the linings of your esophagus to help it show up more clearly on the X-ray images.
In this test, an endoscope is inserted into the esophagus to allow for examination and biopsy of a stricture to determine its cause.
Esophageal pH Monitoring
In this test, a tube is inserted through your mouth into your esophagus to measure how much stomach acid enters your esophagus over a 24-hour period.
Treatment will vary depending on the severity of your stricture as well as its underlying cause. Treatment options may include:
In most cases, esophageal dilation, or stretching, is the preferred option. This procedure is performed under general or local anesthesia for your comfort. An endoscope is passed through your mouth and into your esophagus, stomach, and small intestine. A small balloon on the end of the endoscope is inflated to stretch your esophagus.
Instead of an endoscope, your physician may use a long, flexible tube, called a dilator, to achieve the same results.
This procedure may need to be repeated after a period of time to prevent the stricture from narrowing again.
Esophageal Stent Placement
The insertion of esophageal stents can provide relief from stricture. A stent is a thin tube that may be made of plastic, expandable metal, or flexible mesh material. During this procedure, you will be given a local anesthetic to numb your throat and esophagus. Your doctor will use an endoscope to guide the stent into place, directly at the point of stricture.
Diet & Lifestyle
Daily lifestyle and dietary choices can be effective in managing chronic GERD, which is the primary cause of stricture. Recommendations can include:
- avoiding tight clothes
- elevating the head of your bed to reduce backup of stomach contents
- fasting for three hours before bedtime
- losing approximately five percent of your body weight
- stopping smoking
- avoiding alcohol
- choosing smaller, instead of larger, meals
- avoiding foods that cause reflux, such as:
- spicy foods
- fatty foods
- carbonated beverages
- coffee and caffeinated products
- tomato-based foods
- citrus products
Drugs & Medication
Medications also can be an important part of your therapy. A group of acid-blocking drugs, known as protein pump inhibitors (PPIs), are the most effective options for managing GERD and preventing the backup of stomach acid that can damage your esophagus.These drugs act by blocking the so-called proton pump (enzymes), which leads to a reduced release of stomach acid. Your physician may prescribe these medications for short-term relief to allow your stricture to heal, or long-term therapy to prevent recurrence.
The PPIs used to control GERD include:
Other medications may also be effective in treating GERD and reducing your risk of stricture. They are:
- antacids, which provide short-term relief by neutralizing the stomach’s acids
- sucralfate, which provides a barrier that lines the esophagus and stomach to protect it from acidic stomach juices
- medications such as ranitidine and famotidine, which decrease the secretion of acid
If medication and esophageal dilation are ineffective, your physician may recommend esophageal surgery. A surgical procedure can repair your lower esophageal sphincter, which is the valve between your esophagus and stomach. When working properly, it prevents the reflux of acid into the esophagus; however, this valve is dysfunctional in cases of GERD. By repairing the valve, this surgical technique allows for complete control of GERD symptoms.
Treatment can be difficult in the rare cases where stricture is caused by a non-functioning esophagus. In these extreme cases, an esophageal replacement may be the only effective option.
Treatment, while effective, may not be permanent. You may need to take medication throughout your lifetime to control GERD and reduce your risk for stricture. For patients who undergo esophageal dilation, approximately 30 percent require a repeat of the dilation within one year (Banki).
You can help prevent benign esophageal stricture by avoiding substances that can damage your esophagus. Protect children and keep all corrosive household substances out of their reach.
Managing symptoms of GERD can greatly reduce your risk for stricture. Follow your physician’s instructions regarding dietary and lifestyle choices that can minimize the reflux of acid into your esophagus, and take all medication as prescribed to control symptoms of GERD.