Esophageal strictures describe a narrowing of the esophagus, the tube that carries food from your mouth to your stomach. This narrowing can make swallowing difficult, leading to discomfort and sometimes the regurgitation of food or liquids. Various factors can cause these strictures, including inflammation or scarring. Effective treatments are available to alleviate symptoms and improve a person’s quality of life, and addressing this condition promptly can help prevent further complications.
Common Non-Surgical Treatments
Esophageal dilation is a frequently used non-surgical approach to treat strictures, aiming to stretch the narrowed area of the esophagus. This procedure is performed using an endoscope, a thin, flexible tube with a camera, which allows the doctor to visualize the stricture. Dilation can be achieved with balloon dilators, inflated at the stricture site, or with bougies, which are progressively larger tubes passed through the esophagus to widen the opening.
During the procedure, patients are sedated and may experience mild discomfort or a sore throat afterwards. The effectiveness of dilation depends on the stricture’s severity and cause, with some patients requiring multiple sessions to achieve satisfactory widening.
Medication management, particularly with proton pump inhibitors (PPIs), plays an important role, especially when strictures are caused by acid reflux. PPIs work by reducing stomach acid production, which allows inflamed esophageal tissue to heal and helps prevent recurrence. These medications are prescribed in conjunction with dilation to optimize healing and maintain the esophageal opening. Acid suppression with PPIs can be beneficial in initial treatment and long-term management of esophageal strictures.
When Surgery is Needed
Surgical interventions for esophageal strictures are considered when non-surgical methods, such as dilation, are ineffective or when the stricture is very severe or caused by specific underlying conditions. Cases involving recurrent strictures despite multiple dilations, very tight narrowings, or those resulting from tumors or caustic ingestion necessitate a surgical approach. Surgical treatment may also be indicated if an underlying condition, like chronic acid reflux, requires correction to prevent future strictures.
One surgical technique involves stricture resection with re-anastomosis, where the narrowed segment of the esophagus is removed, and the remaining healthy ends are reconnected. In very severe cases, or when a malignant stricture is present, a more extensive procedure called an esophagectomy is performed, involving the removal of part or all of the esophagus. This can be followed by reconstruction using a portion of the stomach or intestine.
Esophageal stent placement offers another option, acting as a temporary or sometimes permanent measure to keep the esophagus open. Stents are small, expandable tubes inserted into the stricture to maintain patency, particularly useful for malignant strictures or those that are difficult to dilate. This method provides continuous widening of the narrowed area, allowing for improved swallowing.
Post-Treatment Recovery and Long-Term Care
Following esophageal dilation, patients experience mild post-procedure symptoms, such as a sore throat or discomfort, which can be managed with over-the-counter pain relievers. For those undergoing surgery, recovery involves a hospital stay, pain management, and a gradual return to normal activities. Initial dietary restrictions, involving a liquid or soft food diet for a few weeks, allow the esophagus to heal.
Long-term management involves dietary and lifestyle adjustments to prevent recurrence and maintain esophageal health. Patients may be advised to consume soft foods initially, chew thoroughly, and eat smaller, more frequent meals. Avoiding trigger foods, especially if acid reflux is a contributing factor, and implementing lifestyle changes like elevating the head of the bed during sleep can also be beneficial.
Regular follow-up appointments are important to monitor the condition and address any potential recurrence of symptoms. Depending on the type and cause of the stricture, repeat dilations may be necessary over time. Ongoing medication, particularly PPIs for reflux-related strictures, is a part of long-term care to suppress acid production and promote healing.