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
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
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.
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.
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.
The procedure requires one night stay in the hospital after the operation.