Esophageal Stenosis: Information on Causes, Diagnosis & Treatments

Esophageal Stenosis Overview

Esophageal stenosis (esophageal stricture) is a tightening or narrowing of the esophagus, the tube that brings liquid and food from the mouth to the stomach. The condition is caused by chronic inflammation, surgical procedures, trauma, cancer, radiation, or can be present at birth (congenital).

Any narrowing of the esophagus can interrupt normal swallowing mechanisms causing dysphagia (difficulty in swallowing). The ability to pass liquid and food through the esophagus can become impaired and produce the feeling of fullness in the chest or create the inability to swallow. Some individuals notice a pressure-like sensation that causes a shortness of breath that last for a short time, or prolonged time requiring immediate medical attention.

• What Causes Esophageal Stenosis?
• Common Symptoms and Complications
• Diagnosing Esophageal Stenosis
• Treating the Condition

What Causes Esophageal Stenosis?

Doctors, scientists, and medical researchers believe that accidentally swallowing harsh chemicals, the overproduction of stomach acid, and other irritants can cause significant damage to the esophageal lining leading to esophagitis (inflammation) and scar tissue. Over time, repeated injury can cause the esophagus to narrow to the point that prevents fluids and food from reaching the stomach.

Known causes of esophageal stenosis (stricture) include:

• Persistent GERD (gastroesophageal reflux disease) or consistent backups of gastric acid into the esophagus


• Swallowing corrosive chemicals including household cleaners and battery acid


• Treating esophageal varices (enlarged esophagus veins) that cause severe bleeding


• Scleroderma (systemic sclerosis) related to severe esophageal stricture reflux


• Medication pills can become lodged in the esophagus and cause significant irritation


• Esophageal cancer and other malignant conditions that narrow the esophagus


• Prolonged use of nasogastric feeding tubes during hospital stays


• Postoperative strictures developed after esophageal surgery


• Injuries caused by use of an endoscope


• Radiation therapy to the neck or chest


• Achalasia where muscles at the end of the esophagus gradually thicken

Frequent exposure to damaging stomach acid allows the formation of scar tissue to occur that will eventually narrow the esophagus. Individuals most at risk are those who suffer from GERD where the lower esophageal sphincter fails to tighten are close properly. This failure allows stomach acid to flow backward (reflux) into the esophagus and creates a burning sensation felt in the lower chest that is typically described as heartburn.

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Common Symptoms and Complications

The type of symptoms felt by the individual suffering from esophageal stenosis often depends on the degree of the stricture, its location, and cause. However, the most common esophageal stenosis (stricture) symptoms include:

• Painful, difficult swallowing (dysphagia)


• Unexpected weight loss


• Sensations of heartburn and chest pain, especially after consuming meals


• Throwing up blood


• Frequent hiccups or burps


• Feeling as though something is stuck in the throat or chest after a meal or swallowing pills


• Regurgitating liquids or foods


• Increased salvation

Many of the symptoms can cause significant complications if the esophageal stricture does not receive proper treatment. This includes solid and dense foods becoming lodged deep within the esophagus because of its narrowing. This could cause difficulty in breathing, choking, or the sensation of choking.

Other complications include malnutrition and dehydration because the individual is not able to consume enough fluids and liquid due to the difficulty in swallowing. Without effective treatment, the individual can experience pulmonary aspiration when fluid, food, or vomit enters the lungs. If this condition is not corrected, the individual can develop aspiration pneumonia, which is a bacterial infection that develops around the fluid, vomit, or food that backed up into the lung.

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Diagnosing Esophageal Stenosis

Typically, esophageal stenosis (stricture) is first diagnosed after the patient discusses symptoms with their doctor. The physician will collect a detailed medical history and perform a comprehensive physical examination. If stenosis of the esophagus is suspected, the doctor will likely refer the patient to a gastroenterologist who specializes in the G.I. tract to rule out malignancy and confirm the diagnosis after a series of tests that include:

• Barium Esophragm (Swallow) – This procedure requires an x-ray taken after the patient swallows a barium thick liquid that temporarily coats the lining of the esophagus and throat to produce clear, sharp imaging of the G.I. tract.


• CT (Computerized Tomography) Scan – This procedure requires computer processing x-ray machines that create topographical imaging of the interior structure of the body. Typically, the scan can confirm malignant or benign esophageal stricture.


• Upper G.I. Endoscopic – A flexible endoscope with an attached tiny camera is inserted into the esophagus to allow a visual examination of the interior lining. However, there is a significant risk of a tear or perforation in the esophagus lining or stomach when using this device followed by bleeding and extensive damage.


• Biopsy – Typically, the doctor will take a biopsy of the lesion that is causing the narrowing by using an endoscope. The biopsy will be examined under the microscope to determine the cause of the condition. However, this procedure is often performed only when the doctor suspects a malignant condition exists.


• Esophageal Manometry – The procedure measures the function of the lower esophageal sphincter. However, this type of procedure is not always possible when the esophageal stricture is extremely tight.


• Esophageal pH Monitoring – Routine measurements of the upper G.I. tract pH balance can determine the amount of stomach acid that is backing up (refluxing) into the esophagus. The test is performed by inserting a tube from the mouth into the esophagus that measures pH levels over the course of 24 hours.

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Treating the Condition

The doctor will recommend the best treatment for esophageal stricture (stenosis) depending on the underlying cause and severity of the condition these treatments that could include:

• Esophageal Dilation – Doctors can stretch or dilate the interior of the esophagus to alleviate common symptoms. However, this procedure may need to be repeated if the esophagus continues to narrow months or years later.


• Esophageal Stent Placement – A stent (thin expandable tube) can be placed in the interior of the esophagus to keep it from being blocked to allow the individual to swallow liquids and food.


• Changes in Lifestyle and Diet Choices – Consuming smaller meals, stopping smoking, avoiding the consumption of alcohol, losing weight, and elevating the upper torso to prevent acid reflux can dramatically reduce the chances of developing esophageal stenosis.


• Medicines – Prescription proton pump inhibitors help manage the common side effects and symptoms associated with GERD to prevent the development of esophageal stricture.


• Surgical Options are typically a last option when esophageal dilation and medication are ineffective.

Prognosis

Individuals who undergo esophageal dilation and other procedures often experience a recurrence of the problem within a year, requiring another dilation procedure. Some individuals must take drugs through their entire lifetime to ensure their GERD condition remains under control to reduce the potential risk of developing another case of esophageal stenosis.

Preventing Esophageal Stenosis

Patients can prevent the development of esophageal stenosis (stricture) by avoiding food, substances, and liquids known to damage the esophagus and its lining. Children should be protected from consuming corrosive household substances when all dangerous products are kept out of reach.

Individuals suffering from GERD (gastroesophageal reflux disease) can diminish the potential risk of developing esophageal stricture by following instructions from their doctor in their lifestyle and dietary choices. These recommendations can minimize the risk of acid reflux (acid backing up into the esophagus). Some individuals prevent the development of esophageal stenosis by taking prescription medications to treat and control the common symptoms associated with GERD.

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Sources:

http://www.mayoclinic.org/diseases-conditions/esophagitis/basics/complications/con-20034313

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4216666/

https://my.clevelandclinic.org/health/articles/esophageal-spasms-strictures