Definition An oesophageal stricture is a gradual narrowing of the tube that carries food to the stomach. It occurs when scar tissue builds up in the tube.
What is going on in the body? The oesophagus is a muscular tube that connects the throat with the stomach. After food enters the tube, muscles behind and in front of the food contract and relax in a rhythmic sequence to force it along toward the stomach.
When part of the lining of the oesophagus is damaged, it may become scarred. This makes it fibrous and stiff. A build-up of scar tissue can gradually cause narrowing of part of the oesophagus.
What are the signs and symptoms of the condition? A person may notice:
a feeling that food "gets stuck" in the oesophagus
uncomfortable, but not painful swallowing
stomach contents and acid washing back into the mouth
What are the causes and risks of the condition? A ring of muscle called the lower oesophageal sphincter surrounds the opening between the oesophagus and the stomach. Normally, it opens to allow food to pass into the stomach. If this sphincter weakens or relaxes so that it cannot close tightly, stomach contents splash back up into the oesophagus. This is called gastro-oesophageal reflux and is the cause of heartburn.
The lining of the oesophagus is not designed for this kind of abuse. If the problem is chronic, scar tissue may form and lead to a stricture. Less common causes of stricture include:
severe or prolonged infections of the oesophagus, known as oesophagitis
swallowing a caustic substance
complications of medical treatment, such as pill-induced oesophagitis
an x-ray study called a cine-esophagram, in which the person swallows a radio-opaque liquid to help determine the location and length of the stricture
What are the long-term effects of the condition? Even after successful treatment, strictures tend to recur. A stricture caused by drinking lye is thought to be associated with oesophageal cancer decades later.
What are the risks to others? There are no risks to others.
What are the treatments for the condition? Usually, strictures are treated by using a tool to dilate or widen the oesophagus. A person may be given a local anaesthetic to numb the area. Then a rigid, tapered device is pushed through the stricture. Every few days or once a week this is repeated with increasingly larger tools until the person finds it easy to swallow again.
In two other methods of dilation, an endoscope is inserted into the oesophagus. Then a flexible-tip guide wire with a dilator or air-filled balloon is passed through the endoscope to enlarge the constricted passageway.
gastro-oesophageal reflux disease must be treated, too, if it has caused a stricture. Long-term treatment with medications known as proton pump inhibitors, such as omeprazole, lansoprazole, or rabeprazole, have been shown to keep these strictures from recurring.
Surgery may be required if a stricture cannot be dilated enough for solid food to pass through, or if repeated dilations fail to keep it open.
What are the side effects of the treatments? Problems related to treatment may include:
side effects of medication used to treat gastro-oesophageal reflux, such as allergic reactions or stomach upset
What happens after treatment for the condition? In some cases, an oesophageal stricture recurs after treatment. After successful treatment, a person can generally go back to regular activities.
How is the condition monitored? After the oesophageal stricture has been treated, the person should report any new symptoms to the doctor.
Author: David J. Craner, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
