Oesophageal Stricture

A benign oesophageal stricture, also known as a peptic stricture, is a medical condition characterised by the narrowing or tightening of the oesophagus, leading to difficulties in swallowing.

Signs and Symptoms

Patients with oesophageal strictures commonly experience a variety of symptoms that can significantly impact their quality of life. These symptoms include heartburn, a bitter or acid taste in the mouth, and choking. Additionally, patients may suffer from coughing, shortness of breath, frequent burping or hiccups, pain or trouble swallowing, and, in more severe cases, throwing up blood or experiencing weight loss.

These symptoms can vary in intensity and may progressively worsen if the condition is left untreated.

Causes

Oesophageal strictures can arise from multiple causes, often linked to underlying medical conditions or treatments. One of the primary causes is gastroesophageal reflux disease (GERD), which involves the backflow of stomach acid into the oesophagus, leading to inflammation and subsequent scarring.

Other potential causes include esophagitis, a dysfunctional lower oesophageal sphincter, and disordered motility. Ingestion of harmful substances such as lye, as well as anatomical abnormalities like a hiatal hernia, can also contribute to the development of strictures.

Moreover, medical interventions such as oesophageal surgery, laser therapy, or photodynamic therapy can result in scar tissue formation, which tightens and narrows the oesophagus, making swallowing difficult.

Diagnosis

Diagnosing oesophageal strictures involves a combination of imaging techniques and clinical evaluations. One commonly used method is a barium study of the oesophagus, where the patient swallows barium, and X-rays are taken to visualise the narrowed areas. Computerised tomography (CT) scans can also provide detailed images of the oesophagus, aiding in the diagnosis.

Additionally, a biopsy may be performed to examine tissue samples for any underlying conditions. Endoscopy, a procedure where a flexible tube with a camera is inserted into the oesophagus, allows direct visualisation and assessment of the stricture.

Treatment

The treatment approach for oesophageal strictures depends on the underlying cause and the severity of the condition. If the stricture is caused by esophagitis resulting from an infection, treating the infection with antibiotics is a common approach. To physically open the stricture, a surgical procedure involving the insertion of a bougie, a weighted tube, can be performed to dilate the constricted areas of the oesophagus.

Medications may also play a significant role in managing the condition. For instance, H2 antagonists like ranitidine or proton-pump inhibitors like omeprazole can effectively treat underlying acid reflux disease, thereby reducing inflammation and preventing further scarring.

Epidemiology

Gastroesophageal reflux disease (GERD) is a prevalent condition, affecting approximately 40% of adults. Among those with untreated GERD, oesophageal strictures occur in 7–23% of patients. This highlights the importance of early diagnosis and management of GERD to prevent the development of strictures and associated complications.

Understanding the intricacies of oesophageal strictures is very important for healthcare professionals, including dentists, who may encounter patients with related symptoms or conditions in their practice. This knowledge aids in the timely referral and appropriate management of such cases, ultimately improving patient outcomes.

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Self-assessment MCQs (single best answer)

What is a benign oesophageal stricture also known as?

Which medical specialty primarily deals with oesophageal strictures?

Which of the following is NOT a common symptom of oesophageal strictures?

What is a primary cause of oesophageal strictures?

Which diagnostic method involves the patient swallowing barium for X-ray visualisation of the oesophagus?

Which medication class is used to treat underlying acid reflux disease in oesophageal stricture patients?

What can be a consequence of untreated gastroesophageal reflux disease (GERD)?

What is the primary purpose of a bougie in the treatment of oesophageal strictures?

What percentage of adults are affected by gastroesophageal reflux disease (GERD)?

Which imaging technique provides detailed images of the oesophagus and can aid in diagnosing strictures?