Esophageal Strictures-II: Clinical Features and Management

Esophageal stricture typically begins with difficulty swallowing solid foods, which may progress to include liquids. Patients often experience chest pain, regurgitation of food and fluids, heartburn, unintentional weight loss, and coughing or choking during meals. Hoarseness may also occur. These symptoms warrant prompt medical evaluation to confirm diagnosis and prevent complications.

Diagnosis begins with a comprehensive medical history and physical examination. Upper GI endoscopy is the primary diagnostic tool, allowing direct visualization of esophageal narrowing. A biopsy of the stricture is obtained to rule out malignancy. Barium swallow imaging may be performed to evaluate stricture severity, level, and extent, and to exclude conditions like foreign body impaction or diaphragmatic hernia.

Endoscopic dilation is a common treatment for benign esophageal strictures. A dilator, either a bougie or balloon, is inserted through an endoscope to the strictured region. Once visible, the balloon is inflated to widen the narrowed esophageal area. This procedure may require periodic repetition to maintain adequate esophageal diameter and restore normal swallowing function.

Stents, which are metal or plastic tubes, are primarily used for malignant-related esophageal strictures. They are placed endoscopically to keep the narrowed area expanded and maintain esophageal patency. Stent placement is particularly beneficial when benign stricture treatments prove ineffective or when malignancy requires palliative management to improve swallowing and quality of life.

Medical management targets underlying causes, particularly gastroesophageal reflux disease, using H2 blocker antagonists or proton pump inhibitors to reduce stomach acid production. These medications help prevent acid-induced esophageal injury and stricture formation. Combined with lifestyle modifications such as avoiding spicy and fatty foods, eliminating alcohol and smoking, and eating smaller meals, medical management significantly reduces stricture risk.

Esophagectomy is considered for severe or complicated strictures when endoscopic dilation and stent placement prove ineffective. This surgical procedure involves removing the narrowed esophageal portion and reconnecting the healthy segments. Surgery is typically reserved for cases resistant to conservative treatments and requires careful patient selection due to associated morbidity and recovery demands.

Lifestyle modifications are crucial for managing strictures and preventing recurrence. Patients should avoid spicy, fatty foods and caffeinated or carbonated beverages, abstain from alcohol, and quit smoking. Consuming smaller meals, avoiding eating close to bedtime, elevating the head of the bed, and maintaining a healthy weight all reduce acid reflux and esophageal irritation, supporting long-term stricture management.