Oesophageal strictures Home A-Z Health Information Health Library A-Z Oesophageal Strictures Overview Types of oesophageal strictures. EoE, Eosinophilic esophagitisOesophageal strictures refer to the narrowing or tightening of the oesophagus, which can cause difficulty swallowing (dysphagia), regurgitation, and discomfort. These strictures are caused by varied factors, including inflammatory, neoplastic, traumatic, and congenital factors. The narrowing can be partial or complete, and the degree of severity can vary. Oesophageal strictures can develop over time and lead to progressive difficulty in swallowing. Types Strictures can be broadly classified based on their aetiology (underlying cause) and the mechanisms involved in their formation.Benign oesophageal strictures: These are non-cancerous strictures caused by chronic injury, inflammation, or scarring of the oesophageal lining.Corrosive stricturesRadiation-induced stricturesEosinophilic esophagitis (EoE) stricturesPost-surgical stricturesAchalasia-related stricturesPeptic (gastroesophageal reflux disease - GERD) stricturesMalignant oesophageal strictures: These strictures occur due to oesophageal cancer or metastatic cancer that involves the oesophagus.Congenital oesophageal strictures: These strictures are present at birth and are relatively rare.Congenital oesophageal atresia with strictures Features associated with various oesophageal strictures TypeCauseRegion affectedSymptomsPeptic (GERD) strictureChronic acid reflux causing fibrosisDistal oesophagus (near LES)Dysphagia, heartburn, regurgitationCorrosive strictureIngestion of caustic substances (acids or alkalis)Middle to distal oesophagusImmediate pain, dysphagia, aspirationRadiation-induced strictureRadiation therapy for cancersMiddle to distal oesophagusDysphagia, chest painEosinophilic esophagitis (EoE) strictureChronic allergic inflammationProximal to mid-oesophagusDysphagia, food impactionPost-surgical strictureScarring after surgery (e.g., fundoplication, esophagectomy)Near the site of surgeryDysphagia, regurgitationAchalasia-related strictureDysfunctional motility in achalasiaDiffuse, often at LES*Progressive dysphagia, regurgitationMetastatic strictureSpread from primary cancersAny part of the oesophagusDysphagia, weight loss, regurgitationCongenital strictureAbnormal foetal development (atresia, webs)Upper oesophagusFeeding difficulties, aspiration (in neonates)*LES, Lower oesophageal sphincter Causes and risk factors Gastroesophageal reflux disease (Peptic Stricture)Eosinophilic oesophagitis: An allergic condition where eosinophils (a type of white blood cell) infiltrate the oesophagus, leading to inflammation and fibrosis. (EoE stricture)Radiation therapyAchalasiaCorrosion-related oesophageal injury: Injuries caused by swallowing corrosive substances, like acids or alkalis, can result in strictures. (Corrosive stricture)Infections: Certain infections (like candida or herpes) may cause oesophageal damage, leading to stricture formation.Surgical complications (Post-surgical stricture)Oesophageal cancer (Malignant stricture)Hiatal herniaPeptic ulcersForeign body ingestionCongenital issuesPlummer-Vinsion syndromeFamily history of allergies or asthmaAge Symptoms Dysphagia (difficulty swallowing)Odynophagia (painful swallowingRegurgitationWeight lossHeartburnCoughing or chokingPersistent hiccups Diagnosis Upper endoscopy (esophagogastroduodenoscopy, EGD): This is the most definitive diagnostic tool for oesophageal strictures. During EGD, a camera bound to a fine tube is guided into the oesophagus through the mouth to confirm or negate the presence of a stricture and take biopsies if needed. Endoscopy also helps assess the degree of damage (inflammation, ulceration, and scarring).Barium swallow (X-ray): A contrast study where the patient swallows a barium solution, allowing radiologists to see the contours of the oesophagus and identify any narrowing or blockages. This technique can show the location and extent of the stricture, and is useful for assessing motilityOesophageal manometry: This test measures the pressure and muscle function and motility of the oesophagus and lower oesophageal sphincter.CT or MRI: These imaging modalities can determine stricture position and severity, and rule out other causes, such as tumours. Treatment Endoscopic treatment: This is generally performed for established strictures.Endoscopic balloon dilation: One of the primary treatments for oesophageal strictures is endoscopic dilation, where a balloon is inflated to stretch the narrowed part of the oesophagus.Laser therapy: It may be used for treating strictures, particularly if the narrowing is severe or resistant to dilation.Oesophageal stenting: If dilation is ineffective or the stricture recurs frequently, a stent might be inserted to keep the oesophagus open. This is usually considered a temporary or adjunctive solution.Neutralisation: In case of corrosive strictures, or strictures caused by ingestion of a chemical, neutralisation of the chemical immediately after consumption is an effective management strategy.Medications:Proton pump inhibitors (PPIs): If the stricture is caused by GERD, PPIs can reduce acid production, decreasing further damage to the oesophagus.H2-receptor antagonists: Similar to PIPs, these antagonists also decrease stomach acid production; however, these are less effective.Antacids: These can provide temporary relief for heartburn symptoms.Corticosteroids: For eosinophilic oesophagitis, corticosteroids can reduce inflammation and prevent further scarring.Antibiotics or antifungals: If an infection (such as Candida) is the cause, appropriate antimicrobial therapy will be needed.Surgical intervention: In severe cases or when dilation fails, surgery may be required. This could involve cutting away the affected portion or creating a bypass.Dietary modifications: Patients are often advised to avoid foods that might irritate the oesophagus, particularly acidic or spicy foods. Depending on stricture severity, a soft food diet or liquid diet might be recommended.Management of underlying conditions: Treating the underlying cause, such as controlling GERD, managing eosinophilic oesophagitis, or treating achalasia, is crucial for preventing recurrence of strictures.