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What is benign esophageal stricture?
Benign esophageal stricture describes a narrowing or tightening of the esophagus. The esophagus is the tube that brings food and liquids from your mouth to your stomach. “Benign” means it’s not cancerous.
Benign esophageal stricture typically occurs when stomach acid and other irritants damage the lining of the esophagus over time. This leads to inflammation (esophagitis) and scar tissue, which causes the esophagus to narrow.
Although benign esophageal stricture isn’t a sign of cancer, the condition can cause several problems. Narrowing of the esophagus may make it difficult to swallow. This increases the risk of choking. It can also lead to complete obstruction of the esophagus. This can prevent food and fluids from reaching the stomach.
Benign esophageal stricture can happen when scar tissue forms in the esophagus. This is often the result of damage to the esophagus. The most common cause of damage is gastroesophageal reflux disease (GERD), also known as acid reflux.
GERD occurs when the lower esophageal sphincter (LES) doesn’t close or tighten properly. The LES is the muscle between the esophagus and the stomach. It normally opens for a short amount of time when you swallow. Stomach acid can flow back up into the esophagus when it doesn’t close completely. This creates a burning sensation in the lower chest known as heartburn.
Frequent exposure to harmful stomach acid can cause scar tissue to form. Eventually, the esophagus will narrow.
Other causes of benign esophageal stricture include:
- radiation therapy to the chest or neck
- accidental swallowing of an acidic or corrosive substance (such as batteries or household cleaners)
- extended use of a nasogastric tube (a special tube that carries food and medicine to the stomach through the nose)
- esophageal damage caused by an endoscope (a thin, flexible tube used to look inside a body cavity or organ)
- treatment of esophageal varices (enlarged veins in the esophagus that can rupture and cause severe bleeding)
Typical symptoms of benign esophageal stricture include:
- difficult or painful swallowing
- unintended weight loss
- regurgitation of food or liquids
- sensation of something stuck in the chest after you eat
- frequent burping or hiccups
Dense and solid foods can lodge in the esophagus when it narrows. This may cause choking or difficulty breathing.
There’s also a risk of getting pulmonary aspiration, which occurs when vomit, food, or fluids enter your lungs. This could result in aspiration pneumonia, an infection caused by bacteria growing around the food, vomit or fluids in the lung.
Your doctor may use the following tests to diagnose the condition:
Barium swallow test
A barium swallow test includes a series of X-rays of the esophagus. These X-rays are taken after you drink a special liquid containing the element barium. Barium isn’t toxic or dangerous. This contrast material temporarily coats the lining of your esophagus. This allows your doctor to see your throat more clearly.
Upper GI endoscopy
In an upper gastrointestinal (upper GI) endoscopy, your doctor will place an endoscope through your mouth and into your esophagus. An endoscope is a thin, flexible tube with an attached camera. It allows your doctor to examine your esophagus and upper intestinal tract.
Your doctor can use forceps (tongs) and scissors attached to the endoscope to remove tissue from the esophagus. They’ll then analyze this sample of tissue to find the underlying cause of your benign esophageal stricture.
Esophageal pH monitoring
This test measures the amount of stomach acid that enters your esophagus. Your doctor will insert a tube through your mouth into your esophagus. The tube is usually left in your esophagus for at least 24 hours.
Treatment for benign esophageal stricture varies depending on the severity and underlying cause.
Esophageal dilation, or stretching, is the preferred option in most cases. Esophageal dilation can cause some discomfort, so you’ll be under general or moderate sedation during the procedure.
Your doctor will insert an endoscope through your mouth into your esophagus, stomach, and small intestine. Once they see the strictured area, they’ll place a dilator into the esophagus. The dilator is a long, thin tube with a balloon at the tip. Once the balloon inflates, it will expand the narrowed area in the esophagus.
Your doctor may need to repeat this procedure in the future to prevent your esophagus from narrowing again.
Esophageal stent placement
The insertion of esophageal stents can provide relief from esophageal stricture. A stent is a thin tube made of plastic, expandable metal, or a flexible mesh material. Esophageal stents can help keep a blocked esophagus open so you can swallow food and liquids.
You’ll be under general or moderate sedation for the procedure. Your doctor will use an endoscope to guide the stent into place.
Diet & lifestyle
Making certain adjustments to your diet and lifestyle can effectively manage GERD, which is the primary cause of benign esophageal stricture. These changes can include:
- elevating your pillow to prevent stomach acid from flowing back up into your esophagus
- losing weight
- eating smaller meals
- not eating for three hours before bedtime
- quitting smoking
- avoiding alcohol
You should also avoid foods that cause acid reflux, such as:
- spicy foods
- fatty foods
- carbonated beverages
- coffee and caffeinated products
- tomato-based foods
- citrus products
Medications can also be an important part of your treatment plan.
A group of acid-blocking drugs, known as proton pump inhibitors (PPIs), are the most effective medications for managing the effects of GERD. These drugs act by blocking the proton pump, a special type of protein, which helps reduce the amount of acid in the stomach.
Your doctor may prescribe these medications for short-term relief to allow your stricture to heal. They may also recommend them for long-term treatment to prevent recurrence.
The PPIs used to control GERD include:
Other medications may also be effective for treating GERD and reducing your risk of esophageal stricture. They are:
- antacids: provide short-term relief by neutralizing acids in the stomach
- sucralfate (Carafate): provides a barrier that lines the esophagus and stomach to protect them from acidic stomach juices
- antihistamines, such as famotidine (Pepcid AC): decrease the secretion of acid
Your doctor may recommend surgery if medication and esophageal dilation are ineffective. A surgical procedure can repair your LES and help prevent GERD symptoms.
Treatment can correct benign esophageal stricture and help relieve the associated symptoms. However, the condition can occur again. Among the people who undergo esophageal dilation, approximately 30 percent need another dilation within one year.
You may need to take medication throughout your lifetime to control GERD and reduce your risk of developing another esophageal stricture.
You can help prevent benign esophageal stricture by avoiding substances that can damage your esophagus. Protect your children by keeping all corrosive household substances out of their reach.
Managing symptoms of GERD can also greatly reduce your risk for esophageal stricture. Follow your doctor’s instructions regarding dietary and lifestyle choices that can minimize the backup of acid into your esophagus. It’s also important to make sure you take all medications as prescribed to control symptoms of GERD.