Esophageal stricture medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
* The mainstay of treatment for esophageal stricture is dilation.<ref name="pmid7926495">{{cite journal |vauthors=Smith PM, Kerr GD, Cockel R, Ross BA, Bate CM, Brown P, Dronfield MW, Green JR, Hislop WS, Theodossi A |title=A comparison of omeprazole and ranitidine in the prevention of recurrence of benign esophageal stricture. Restore Investigator Group |journal=Gastroenterology |volume=107 |issue=5 |pages=1312–8 |year=1994 |pmid=7926495 |doi= |url=}}</ref> Self dilation can be | * The mainstay of treatment for esophageal stricture is dilation.<ref name="pmid7926495">{{cite journal |vauthors=Smith PM, Kerr GD, Cockel R, Ross BA, Bate CM, Brown P, Dronfield MW, Green JR, Hislop WS, Theodossi A |title=A comparison of omeprazole and ranitidine in the prevention of recurrence of benign esophageal stricture. Restore Investigator Group |journal=Gastroenterology |volume=107 |issue=5 |pages=1312–8 |year=1994 |pmid=7926495 |doi= |url=}}</ref> Self dilation can be considered at home with bougie dilators <ref name="pmid23925823">{{cite journal |vauthors=Dzeletovic I, Fleischer DE, Crowell MD, Pannala R, Harris LA, Ramirez FC, Burdick GE, Rentz LA, Spratley RV, Helling SD, Alexander JA |title=Self-dilation as a treatment for resistant, benign esophageal strictures |journal=Dig. Dis. Sci. |volume=58 |issue=11 |pages=3218–23 |year=2013 |pmid=23925823 |doi=10.1007/s10620-013-2822-7 |url=}}</ref> | ||
* Pharmacologic medical therapy is recommended among all patients who develop esophageal stricture due to gastroesophageal reflux disease. Studies show proton pump inhibitors are more effective than acid blocking agent<ref name="pmid7926495" /><ref name="pmid7848395">{{cite journal |vauthors=Marks RD, Richter JE, Rizzo J, Koehler RE, Spenney JG, Mills TP, Champion G |title=Omeprazole versus H2-receptor antagonists in treating patients with peptic stricture and esophagitis |journal=Gastroenterology |volume=106 |issue=4 |pages=907–15 |year=1994 |pmid=7848395 |doi= |url=}}</ref> | * Pharmacologic medical therapy is recommended among all patients who develop esophageal stricture due to gastroesophageal reflux disease. Studies show proton pump inhibitors are more effective than acid blocking agent<ref name="pmid7926495" /><ref name="pmid7848395">{{cite journal |vauthors=Marks RD, Richter JE, Rizzo J, Koehler RE, Spenney JG, Mills TP, Champion G |title=Omeprazole versus H2-receptor antagonists in treating patients with peptic stricture and esophagitis |journal=Gastroenterology |volume=106 |issue=4 |pages=907–15 |year=1994 |pmid=7848395 |doi= |url=}}</ref> | ||
Revision as of 21:25, 7 November 2017
Main stay of treatment of esophageal stricture is dilatation.
Proton pump inhibitors also help in prevention of recurrence after surgical esophageal dilatation.
Proton pump inhibitors have been found more effective in acid suppression in these patients as compared to H2 blockers.
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
The mainstay of treatment for esophageal stricture is dilation. Supportive medical therapy for esophageal stricture secondary to gastroesophageal reflux disease includes proton pump inhibitors or H2 antagonists.
OR
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
OR
The majority of cases of [disease name] are self-limited and require only supportive care.
OR
[Disease name] is a medical emergency and requires prompt treatment.
OR
OR The optimal therapy for [malignancy name] depends on the stage at diagnosis.
OR
[Therapy] is recommended among all patients who develop [disease name].
OR
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
OR
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
OR
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
OR
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
Medical Therapy
- The mainstay of treatment for esophageal stricture is dilation.[1] Self dilation can be considered at home with bougie dilators [2]
- Pharmacologic medical therapy is recommended among all patients who develop esophageal stricture due to gastroesophageal reflux disease. Studies show proton pump inhibitors are more effective than acid blocking agent[1][3]
- Life Style Modification
- Antibiotics for infectious causes of esophageal stricture
- Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
- Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
- Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
- Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
- Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
- Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
Esophageal stricture
- Adult[6]
- Preferred regimen : Omeprazole (Prilosec) :20 mg PO daily following esophageal dilatation.
- Omeprazole (Prilosec): 40 mg twice daily for patients who do not respond to the standard dose
- Alternative regimen : Ranitidine 150 mg twice daily
- Preferred regimen : Omeprazole (Prilosec) :20 mg PO daily following esophageal dilatation.
- Pediatric[7]
- Omeprazole 2 mg/kg PO per day
Neonates (Off-label)
Refractory duodenal ulcer or reflux esophagitis: 0.5-1.5 mg/kg PO qDay for up to 8 weeks
References
- ↑ 1.0 1.1 Smith PM, Kerr GD, Cockel R, Ross BA, Bate CM, Brown P, Dronfield MW, Green JR, Hislop WS, Theodossi A (1994). "A comparison of omeprazole and ranitidine in the prevention of recurrence of benign esophageal stricture. Restore Investigator Group". Gastroenterology. 107 (5): 1312–8. PMID 7926495.
- ↑ Dzeletovic I, Fleischer DE, Crowell MD, Pannala R, Harris LA, Ramirez FC, Burdick GE, Rentz LA, Spratley RV, Helling SD, Alexander JA (2013). "Self-dilation as a treatment for resistant, benign esophageal strictures". Dig. Dis. Sci. 58 (11): 3218–23. doi:10.1007/s10620-013-2822-7. PMID 23925823.
- ↑ Marks RD, Richter JE, Rizzo J, Koehler RE, Spenney JG, Mills TP, Champion G (1994). "Omeprazole versus H2-receptor antagonists in treating patients with peptic stricture and esophagitis". Gastroenterology. 106 (4): 907–15. PMID 7848395.
- ↑ Richter, Joel (2009). "Advances in GERD Current Developments in the Management of Acid-Related GI Disorders". Gastroenterol Hepatol (N Y). 5: 613–615.
- ↑ Kaltenbach T, Crockett S, Gerson LB (2006). "Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach". Arch. Intern. Med. 166 (9): 965–71. doi:10.1001/archinte.166.9.965. PMID 16682569.
- ↑ Smith PM, Kerr GD, Cockel R, Ross BA, Bate CM, Brown P, Dronfield MW, Green JR, Hislop WS, Theodossi A (1994). "A comparison of omeprazole and ranitidine in the prevention of recurrence of benign esophageal stricture. Restore Investigator Group". Gastroenterology. 107 (5): 1312–8. PMID 7926495.
- ↑ Hagander, Lars; Muszynska, Carolina; Arnbjornsson, Einar; Sandgren, Katarina (2012). "Prophylactic Treatment with Proton Pump Inhibitors in Children Operated on for Oesophageal Atresia". European Journal of Pediatric Surgery. 22 (02): 139–142. doi:10.1055/s-0032-1308698. ISSN 0939-7248.