The esophagus, a muscular tube connecting the mouth to the stomach, transports food and liquids. While the esophagus doesn’t “shrink” like a muscle, it can narrow or become constricted, a condition known as esophageal stricture or stenosis. This occurs when the inner passageway tightens, impeding the normal flow of swallowed contents.
What is Esophageal Narrowing?
Esophageal narrowing, or stricture, is a reduction in the internal diameter of the esophageal lumen, the channel through which food passes. This constriction makes it progressively difficult for solids and, at times, even liquids to travel from the mouth to the stomach. The physical change involves alterations to esophageal tissue, leading to a loss of its natural flexibility.
This narrowing arises from inflammation, scarring, or the formation of fibrous tissue within the esophageal wall. These changes can occur on the inside lining (mucosa), causing it to swell or stiffen, or from external pressure exerted by neighboring organs or growths. The process develops slowly, making swallowing increasingly challenging.
Common Causes of Esophageal Narrowing
A frequent cause of esophageal narrowing is gastroesophageal reflux disease (GERD). Chronic exposure to stomach acid backing up into the esophagus leads to inflammation and irritation. Over time, this persistent inflammation results in scar tissue formation, or fibrosis, which causes the esophagus to narrow. This accounts for 70% to 80% of benign esophageal strictures in adults.
Another cause is eosinophilic esophagitis (EoE), an allergic inflammatory condition where eosinophils accumulate in the esophageal lining. This triggers inflammation, which, if untreated, can lead to scarring and narrowing. Radiation therapy, particularly for cancers in the head, neck, or chest, can induce inflammation and scarring in the esophagus, potentially causing strictures.
Ingestion of corrosive substances, such as household cleaners or certain chemicals, can cause severe damage to the esophageal lining. This injury leads to significant scarring and stricture formation, sometimes weeks or years after initial exposure. Less common causes include injuries from medical procedures, long-term medications, or rare skin diseases affecting mucosal surfaces.
Recognizing Symptoms and Getting Diagnosed
Individuals with esophageal narrowing experience symptoms related to impaired swallowing. The most common symptom is dysphagia, or difficulty swallowing, initially noticed with solid foods and gradually progressing to liquids as narrowing worsens. People might describe food getting stuck in their throat or chest, or moving slowly.
Other symptoms include pain or discomfort during swallowing, sometimes described as a burning sensation. Unintentional weight loss can occur due to reduced food intake, and regurgitation, where food comes back up, is also possible. These symptoms worsen over time as the stricture becomes more pronounced.
To identify esophageal narrowing, medical professionals use diagnostic procedures. An esophagram, also known as a barium swallow test, involves drinking a liquid that coats the esophagus, allowing its shape and any narrowing to be visualized on X-ray images. Another method is an upper endoscopy, or EGD (esophagogastroduodenoscopy), where a thin, flexible tube with a camera is guided down the throat to view the esophageal lining and take tissue samples (biopsies) if needed. Biopsies help determine the underlying cause.
Treatment Approaches and Prognosis
Treatment for esophageal narrowing focuses on widening the constricted area and addressing the underlying cause to prevent recurrence. The most common intervention is esophageal dilation, which involves stretching the narrowed segment using balloon dilators or bougies. This procedure is often performed during an endoscopy, and multiple sessions may be required depending on the stricture’s severity.
Medications play a role in managing the root cause. For strictures related to GERD, proton pump inhibitors (PPIs) are prescribed to reduce stomach acid and decrease inflammation. For eosinophilic esophagitis, corticosteroids may be used to reduce allergic inflammation. For complex or recurrent strictures, steroid injections at the site of dilation can help reduce inflammation and prevent re-narrowing.
In severe instances where other treatments are ineffective, or if narrowing is due to cancer, surgical intervention might be considered. The prognosis for esophageal strictures is favorable with proper management. Many individuals experience relief from symptoms and an improved quality of life. Ongoing treatment of the underlying condition is important to minimize the risk of recurrence.