An Overview of Esophageal Strictures
Esophageal strictures can involve only part of the esophagus or all of it, depending on the root cause. In addition, they can result from both benign (noncancerous) and malignant (cancerous) conditions.
Doctors categorize benign esophageal strictures as either simple or complex, depending on how much of the esophagus they affect.
Simple esophageal strictures are most common and are less than 2 centimeters (cm) long. Complex strictures are often longer, resistant to treatment, and recurrent.
The average esophagus usually measures up to 30 millimeters (mm) across. With a symptomatic esophageal stricture, the esophagus often measures 13 mm or less across. Less severe strictures may not always cause symptoms.
Below are some common benign, or noncancerous, causes of esophageal strictures.
Gastroesophageal reflux disease
An estimated 70–80% of adult esophageal strictures are caused by long-term gastroesophageal reflux disease (GERD), commonly called acid reflux. Researchers think ongoing inflammation of the esophagus causes these types of strictures.
Over-the-counter proton pump inhibitors (PPIs) that treat GERD can reduce the number of people developing peptic esophageal strictures.
In people with EoE, white blood cells called eosinophils appear in the esophagus, as well as in the stomach and other parts of the intestines.
People with EoE can develop long-term inflammation in the esophagus. A 2019 review stated that the longer EoE remains untreated, the more likely people may be to experience esophageal strictures.
Also known as scleroderma, systemic sclerosis is a rare disease with several subtypes. It causes scar tissue in different areas of the body.
This condition often affects the muscles of the esophagus, making it more difficult to swallow. The cause remains poorly understood.
Damage from injuries
Accidental injury is a common cause of esophageal strictures. Drinking very hot or irritating liquids can hurt the esophagus and cause strictures. Medical procedures like endoscopy, where doctors use a scope to examine your throat and esophagus, can also cause damage in rare cases.
Cancer treatment sometimes includes surgery, chemotherapy, radiation therapy, or a combination of treatments. Radiation treatment for head, neck, and lung cancers can cause radiation-induced esophageal strictures (RIES).
Taking these medications over a long period of time can cause an esophageal stricture to develop.
As part of treatment for head or neck cancer, doctors might perform a procedure known as an esophagectomy, which removes part or all of the esophagus. After this operation, an anastomotic stricture can form where the stomach attaches to the new swallowing tube that replaces the removed part of the esophagus.
Below are two possible malignant causes of esophageal strictures:
- Esophageal cancer: A cancerous tumor of the esophagus, either an esophageal adenocarcinoma or squamous cell carcinoma, can cause esophageal stricture.
- Metastatic cancer: When cancer cells grow outside of their original site, it’s called metastatic cancer. For example, when lung cancer spreads, it can appear as a tumor in the esophagus.
Esophageal strictures can cause a variety of symptoms, including:
- a feeling of food being stuck in your throat
- difficulty swallowing or not being able to swallow at all
- painful swallowing
- chest pain
- weight loss
To diagnose an esophageal stricture, doctors will ask questions about your symptoms and use certain tests to look at your throat.
For an upper gastrointestinal endoscopy, a doctor inserts a small, flexible tube with a light and camera to take a look at your esophagus. They can also take tiny pieces of tissue during an endoscopy to examine under a microscope.
During a contrast barium swallow, you drink a liquid with barium in it, which shows on an X-ray how the liquid is moving through your esophagus. This can help your doctor determine if there’s a blockage or narrowed esophagus.
Lastly, endoscopic ultrasound can help doctors assess the structure of the esophagus to determine if the walls have thickened or if other changes have occurred.
After a diagnosis, doctors will work to fix the stricture. Treatments often include:
- Dilation endoscopy: Using an endoscope in your throat, a doctor inserts a dilation tool to stretch the narrowed part of your esophagus. First, they use a numbing spray on your throat and mouth — and sometimes also mild sedation — before using a dilating balloon or plastic dilators to open your esophagus. Sometimes doctors will use different dilation widths to open the esophagus more each time, or they might use a steroid injection along with dilation. Dilation endoscopy successfully treats more than 80% of benign esophageal strictures.
- Stents: A stent, which helps keep an opening in your body from closing, can help treat esophageal strictures that repeatedly come back after treatment.
- Surgery: Surgical resection may be necessary for malignant conditions or benign strictures that do not respond to other treatments.
In addition, your doctor will prescribe treatments to address the underlying cause of the stricture to try and prevent recurrences.
The outlook for people with esophageal strictures varies depending on how quickly they receive treatment and how well their medical teams can manage the strictures and the underlying conditions.
When you seek treatment quickly, dilation endoscopy and medication usually work very well for peptic strictures caused by GERD. When cancer causes esophageal strictures, surgery is a more successful treatment.
Your doctor will try to find the best treatment so the esophageal stricture doesn’t form again.
Possible complications of esophageal strictures include:
- inhalation of food into the lungs
- food getting stuck in your esophagus
- the development of asthma from inhaling food particles
- chest pain
- holes in the esophagus from long-term inflammation
- esophageal fistula, which is an atypical connection between the esophagus and another organ
Your risk for developing an esophageal stricture varies depending on the underlying cause, but it can increase with a previous history of:
- hiatal hernia
- alcohol use
- difficulty swallowing
- peptic ulcers
- Barrett’s esophagus
- any medication that can cause stomach ulcers
- treatment with endoscopy or surgery on the esophagus
- radiation treatment for cancer in the head, neck, or chest
- medications that can cause esophagitis
- alcohol consumption
Since GERD causes the majority of esophageal strictures, it’s important to seek quick treatment if you develop symptoms such as heartburn, acid reflux, or trouble swallowing. PPIs can help reduce your risk of developing esophageal strictures.
In addition, stopping any tobacco use helps to prevent esophageal, head, neck, and lung cancer.
Esophageal strictures happen when your esophagus narrows and causes difficulty swallowing food or liquids. Many different health conditions, both cancerous and noncancerous, cause esophageal strictures.
It’s important to contact your doctor immediately if you have any trouble swallowing. Getting an accurate diagnosis and quick treatment increases the chances that an esophageal stricture will not happen again.