Esophageal stricture

Esophageal stricture

    * Introduction
    * Causes and Risk Factors
    * Signs and symptoms
    * Diagnosis
    * Treatment
Pathological processes that can produce esophageal strictures can be grouped into three broad categories: intrinsic disorder that destroys the esophageal lumen by inflammation, fibrosis or neoplasm, extrinsic conditions that compromise the esophageal lumen by direct invasion or lymphadenopathy and esophageal peristalsis disorders that disrupt and / or sphincter function by their effects on lower esophageal smooth muscle and its innervation.
Many diseases can cause the formation of esophageal strictures. These include peptic acid, autoimmunity, infections, caustic agents, congenital, iatrogenic, the drug-induced, radiation-induced, malignancies and idiopathic diseases. The etiology of esophageal stricture can usually be identified by endoscopic and radiological modalities can be confirmed by endoscopic visualization and biopsy of tissue. Using manometry can be diagnostic when dysmotility is suspected as the primary pathological process. Computer tomography and endoscopic ultrasound are a real help in stadierea malignant strictures. Fortunately most responsive to pharmacological intervention esophageal strictures, endoscopic or surgical.
Peptic strictures have more than 70-80% of all cases. Gastroesophageal Reflux affects about 40% of adults. Strictures are estimated to occur in 7-23% of untreated patients with reflux disease. Gastroesophageal reflux disease include 70-80% of cases of esophageal strictures. Postoperative strictures has approximately 10% and the corrosive than 5%.
Patients with strictures may be heartburn, dysphagia, odynophagia, imapactarea food, weight loss and chest pain. Progressive dysphagia for solids is the most common initial symptom. It can progress to dysphagia for lighide. The mortality rate is high if perforation occurs or if the stricture is malignant. However, morbidity is significant for peptic strictures. Most patients suffer relapses with increased risk of food impaction and pulmonary aspiration. Barrett's esophagus often coexist. The need for repeated dilations increase the risk of perforation.
The treatment involves mechanical dilation for peptic strictures. Several recent studies show that proton pump inhibitors are highly beneficial to initiate therapy and long term. Endoscopic dilatation and surgical methods for therapeutic control of esophageal stricture are prevalent today. Option for expansion technique depends on many factors, most importantly stricture characteristics.
Some studies show that progressive esophageal dilation of peptic strictures lead to significant improvement of dysphagia in 85% of cases, with a low rate of complications. However 30% of patients require repeated dilation year despite acid suppression. Negative prognostic factors include heartburn and significant weight loss at initial presentation. The prognosis of surgery is dependent on surgeon experience. an excellent prognosis is reported in 77% of cases. Repetition rate of expansion is 1-43% after surgery, requiring at least two sessions. Mortality and morbidity is below 0. 5% and 20%.