Esophageal (e-sofah-JE-al) stricture (STRIK-chur) is a condition where there is a narrowing of the esophagus. The esophagus is the soft tube that carries food and liquid from the throat to the stomach. With an esophageal stricture, an abnormal change or injury may have caused inflammation (swelling) and damage to the esophagus. When the damaged areas heal, scar tissue forms and make the affected area of the esophagus hard. This narrows the esophagus and causes problems for foods and liquids to pass through.
An esophageal stricture may be benign (not cancer) or malignant (cancer). This is based on the abnormal cells that are present in the esophageal stricture. Diagnosing and treating esophageal stricture as soon as possible may relieve its symptoms and prevent other serious health problems.
What causes an esophageal stricture? The main cause of esophageal stricture is a severe (bad) long-standing gastroesophageal reflux disease (GERD). GERD occurs when you have a weak lower esophageal sphincter. A sphincter is a ring-like muscle that opens and closes an opening in your body. If the sphincter relaxes too often, it causes stomach acid to reflux (back up) into the esophagus. This acid irritates and damages the esophagus, which may later lead to scarring and abnormal changes in the cells lining the esophagus. The following are other possible conditions and factors that may increase your risk of having esophageal stricture:
Abnormal esophagus: Some are born with defects in their esophagus, such as stenosis (narrowing) or diverticulosis (pouches).
Esophageal cancer: A malignant tumor of the esophagus may cause it to narrow.
Medicines: Certain medicines may irritate the esophagus, such as aspirin or other pain medicines and antibiotics used for treating malaria.
Surgeries or sclerotherapy: Previous surgeries or sclerotherapy done on the esophagus. Sclerotherapy is done by injecting chemicals into the blood vessels to help stop or control bleeding.
Trauma: Injury caused by exposure to radiation or swallowing strong acids or bases, such as household cleaning liquids. A nasogastric (NG) tube placed for a long time may also damage and form scars in the esophagus. An NG tube is put into your nose and down into your stomach to keep it empty.
Other diseases: Infections, skin diseases, scleroderma, or esophagitis (swelling of the esophagus) may cause tightening, scarring, or narrowing of the esophagus.
What are the signs and symptoms of esophageal stricture? Signs and symptoms of esophageal stricture are usually related to GERD signs and symptoms. Heartburn, the most common symptom of GERD, may also be present in esophageal stricture. It is a feeling of burning pain in your chest or below the sternum (chest bone). This usually occurs after meals and spreads to your neck, jaw, or shoulder. You may feel like food gets stuck going down, after swallowing. You may also have any of the following:
Bitter or acid taste in your mouth.
Black, tarry bowel movements.
Choking, coughing, or shortness of breath.
Frequent burping or hiccups.
Pain or trouble swallowing.
Vomiting (throwing up) blood.
Weight loss.
How is an esophageal stricture diagnosed? You may be given dye before the pictures are taken for some of these tests. The dye is usually given in your IV. The dye may help your caregiver see the pictures better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell the caregiver if you are allergic to shellfish, or have other allergies or medical conditions. You may have one or more of the following tests:
Barium swallow: This test is an x-ray of your throat and esophagus, the tube connecting your throat to your stomach. This test may also be called a barium esophagram. You will drink a thick liquid called barium. Barium helps your esophagus and stomach show up better on x-rays. Follow the instructions of your caregiver before and after the test.
Computerized tomography scan: This test is also called a CT scan. A special x-ray machine uses a computer to take pictures of your esophagus and other organs. The thickness of the stricture may also be measured using a CT scan.
Endoscopy: This test uses a scope to see the inside of your digestive tract. A scope is a long, bendable tube with a light on the end of it. A camera may be hooked to the scope to take pictures. During an endoscopy, caregivers may find problems with how your digestive tract is working. Samples may be taken from your digestive tract and sent to a lab for tests. Small tumors may be removed, and bleeding may be treated during an endoscopy.
How is an esophageal stricture treated? Treatment for esophageal stricture depends on its cause. It includes controlling your symptoms and preventing other serious health problems. Your caregiver may suggest that you make diet and lifestyle changes, such as losing weight. You may also need any of the following:
Dilatation: A dilator, balloon device, or stent may be placed in your esophagus to dilate (widen) it.
Endoscopic therapies: The esophagus may also be made wider by using any of the following therapies:
Ablation: Esophageal stricture may be treated by using a special gas, such as argon, or thermal (heat) energy.
Cautery: A small metal rod that uses electric current is used to burn away abnormal cells.
Injection therapy: Special chemicals, such as alcohol, may be injected into the esophagus to relieve your symptoms.
Laser or photodynamic therapy: Lasers, in combination with medicines that become active when exposed to light, are used to destroy abnormal cells.
Medicines: Medicines may be given to relieve the symptoms caused by esophageal stricture. Anti-reflux medicines help decrease the stomach acid that can irritate your esophagus and stomach. You may also be given medicines to treat scleroderma or cancer.
Surgery: Your caregiver may suggest surgery depending on the type of esophageal stricture that you have. Surgeries may include the following:
Anti-reflux surgery: The sphincter may be strengthened to help prevent reflux.
Resection or esophagectomy: Your caregiver may remove a part of or the entire esophagus.
Where can I find support and more information? Having an esophageal stricture may be life-changing for you. You and those close to you may feel scared, sad, or anxious. These are normal feelings. Talk to your caregiver, family, or friends about your feelings. Contact the following for more information:
American Academy of Family Physicians 11400 Tomahawk Creek Parkway Leawood, KS 66211-2680 Phone: 1-913-906-6000 Phone: 1-800-274-2237 Web Address: http://www.aafp.org
National Digestive Diseases Information Clearinghouse (NDDIC) 2 Information Way Bethesda, MD 20892-3570 Phone: 1-800-8915389 Web Address: www.digestive.niddk.nih.gov
CARE AGREEMENT:
You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.
The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.
