Esophageal stricture
Updates to Article Attributes
Oesophageal strictures refer to any persistent intrinsic narrowing of the oesophagus.
Pathology
Aetiology
The most common causes are fibrosis induced by inflammatory and neoplastic processes. Because radiographic findings are not reliable in differentiating benign from malignant strictures, all should be evaluated endoscopically.
Upper and middle oesophageal strictures
These most commonly result from:
- Barrett oesophagus
- mediastinal radiation
- caustic ingestion
- congenital oesophageal stenosis
- oesophageal intramural pseudodiverticulosis
- skin diseases associated with mucosal ulceration, such as
- pemphigoid
- erythema multiforme
- epidermolysis bullosa dystrophica
Distal oesophageal strictures
These are typically caused by gastro-oesophageal reflux disease (GORD), either as a separate entity, or in the setting of:
- scleroderma
- prolonged nasogastric intubation
- Zollinger-Ellison syndrome: high acidity reflux
- post partial or total gastrectomy: alkaline reflux
- performing the roux-en-Y procedure may avoid this, by diverting the pancreatic secretions and bile away from the gastric remnant
Associations
Oesophageal strictures are often associated with a hiatal hernia.
Radiographic features
Benign strictures
- smoothly tapering
- typically concentric narrowing, but may affect only one side of the oesophagus (asymmetric wall rigidity)
Malignant strictures are characteristically
- abrupt
- asymmetric
- eccentric with irregular, nodular mucosa
Tapered margins may occur with malignant lesions because of the ease of submucosal spread of a tumour.
Treatment and prognosis
The risk of Barrett oesophagus in a stricture is 20-40% and strictures should be evaluated endoscopically.
-</ul><h6>Distal oesophageal strictures</h6><p>These are typically caused by <a href="/articles/gastro-oesophageal-reflux-disease">gastro-oesophageal reflux disease (GORD)</a>, either as a separate entity, or in the setting of:</p><ul>- +</ul><h6>Distal oesophageal strictures</h6><p>These are typically caused by <a href="/articles/gastro-oesophageal-reflux-disease">gastro-oesophageal reflux disease (GORD)</a>, either as a separate entity or in the setting of:</p><ul>
-</ul><p>Tapered margins may occur with malignant lesions because of the ease of submucosal spread of tumour.</p><h4>Treatment and prognosis</h4><p>The risk of <a href="/articles/barrett-oesophagus">Barrett oesophagus</a> in a stricture is 20-40% and strictures should be evaluated endoscopically.</p>- +</ul><p>Tapered margins may occur with malignant lesions because of the ease of submucosal spread of a tumour.</p><h4>Treatment and prognosis</h4><p>The risk of <a href="/articles/barrett-oesophagus">Barrett oesophagus</a> in a stricture is 20-40% and strictures should be evaluated endoscopically.</p>
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