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==Overview==
'''Natural history and management of refractory benign esophageal strictures.'''


Common causes of esophageal stricture include [[gastroesophageal reflux disease]] and caustic ingestions.
'''Natural history and management of refractory benign esophageal strictures'''


==Causes==
'''Peptic esophageal stricture: is surgery still necessary?'''
===Life-threatening Causes===
*Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. There are no life-threatening causes of esophageal stricture, however complications resulting from untreated esophageal stricture is common.
===Common Causes===
Esophageal stricture may be caused by:<ref name="pmid1483661">{{cite journal |vauthors=Csendes A, Braghetto I |title=Surgical management of esophageal strictures |journal=Hepatogastroenterology |volume=39 |issue=6 |pages=502–10 |year=1992 |pmid=1483661 |doi= |url=}}</ref>
*[[Gastroesophageal reflux disease]]<ref name="pmid8338082">{{cite journal |vauthors=Marks RD, Richter JE |title=Peptic strictures of the esophagus |journal=Am. J. Gastroenterol. |volume=88 |issue=8 |pages=1160–73 |year=1993 |pmid=8338082 |doi= |url=}}</ref>
*Caustic ingestions<ref name="pmid4020540">{{cite journal |vauthors=Wasserman RL, Ginsburg CM |title=Caustic substance injuries |journal=J. Pediatr. |volume=107 |issue=2 |pages=169–74 |year=1985 |pmid=4020540 |doi= |url=}}</ref>
*Previous surgery on the esophagus
*Surgical anastomosis
*Radiation therapy for thoracic or head and neck tumors<ref name="pmid7713784">{{cite journal |vauthors=Coia LR, Myerson RJ, Tepper JE |title=Late effects of radiation therapy on the gastrointestinal tract |journal=Int. J. Radiat. Oncol. Biol. Phys. |volume=31 |issue=5 |pages=1213–36 |year=1995 |pmid=7713784 |doi=10.1016/0360-3016(94)00419-L |url=}}</ref>
*Esophageal sclerotherapy<ref name="pmid1928999">{{cite journal |vauthors=Guynn TP, Eckhauser FE, Knol JA, Raper SE, Mulholland MW, Nostrant TT, Elta GH, Barnett JL |title=Injection sclerotherapy-induced esophageal strictures. Risk factors and prognosis |journal=Am Surg |volume=57 |issue=9 |pages=567–71; discussion 571–2 |year=1991 |pmid=1928999 |doi= |url=}}</ref>
*[[Eosinophilic esophagitis]]<ref name="FurutaIngelfinger2015">{{cite journal|last1=Furuta|first1=Glenn T.|last2=Ingelfinger|first2=Julie R.|last3=Katzka|first3=David A.|title=Eosinophilic Esophagitis|journal=New England Journal of Medicine|volume=373|issue=17|year=2015|pages=1640–1648|issn=0028-4793|doi=10.1056/NEJMra1502863}}</ref>
*Treatment for [[esophageal varices]]
*Esophageal cancer
*Increased level of gastric acid exposure to esophageal tissue, for example:
**[[Systemic sclerosis]]
**[[Zollinger-Ellison syndrome]]
**[[Nasogastric tube]] placement
**[[Heller myotomy]] for [[achalasia]]
*[[Esophageal diverticulum|Esophageal diverticula]]<ref name="Smith2015">{{cite journal|last1=Smith|first1=C. Daniel|title=Esophageal Strictures and Diverticula|journal=Surgical Clinics of North America|volume=95|issue=3|year=2015|pages=669–681|issn=00396109|doi=10.1016/j.suc.2015.02.017}}</ref>
*[[Hiatus hernia|Hiatal hernia]]
*[[Tracheoesophageal fistula]]


===Less Common Causes===
'''Predictor of massive bleeding following stent placement for malignant oesophageal stricture/fistulae: a multicentre study'''
Less common causes of esophageal stricture include:
*[[Dyskeratosis congenita|Dyskeratosis congenita (DC)]]<ref name="pmid23279657">{{cite journal| author=Jonassaint NL, Guo N, Califano JA, Montgomery EA, Armanios M| title=The gastrointestinal manifestations of telomere-mediated disease. | journal=Aging Cell | year= 2013 | volume= 12 | issue= 2 | pages= 319-23 | pmid=23279657 | doi=10.1111/acel.12041 | pmc=3602337 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23279657  }}</ref>
*Rare dermatologic diseases (eg, [[epidermolysis bullosa dystrophica]])<ref name="pmid27384758">{{cite journal |vauthors=Guerra-Leal JD, Meester I, Cantu-Gonzalez JR, Ornelas-Cortinas G, Montemayor-Martinez A, Salas-Alanis JC |title=The Importance of Esophagography in Patients With Recessive Dystrophic Epidermolysis Bullosa |journal=AJR Am J Roentgenol |volume= |issue= |pages=1–4 |year=2016 |pmid=27384758 |doi=10.2214/AJR.16.16115 |url=}}</ref>
*Mediastinal fibrosis due to [[TB|tuberclosis]] or idiopathic fibrosing mediastinitis<ref name="pmid7665827">{{cite journal |vauthors=Goenka MK, Gupta NM, Kochhar R, Rungta U, Vaiphei K, Nagi B, Suri S |title=Mediastinal fibrosis: an unusual cause of esophageal stricture |journal=J. Clin. Gastroenterol. |volume=20 |issue=4 |pages=331–3 |year=1995 |pmid=7665827 |doi= |url=}}</ref>
*Drug-induced stricture:<ref name="pmid3606243">{{cite journal| author=Bonavina L, DeMeester TR, McChesney L, Schwizer W, Albertucci M, Bailey RT| title=Drug-induced esophageal strictures. | journal=Ann Surg | year= 1987 | volume= 206 | issue= 2 | pages= 173-83 | pmid=3606243 | doi= | pmc=1493104 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3606243  }}</ref>
**Aspirin and anti-inflammatory agents<ref name="pmid6825537">{{cite journal |vauthors=Kikendall JW, Friedman AC, Oyewole MA, Fleischer D, Johnson LF |title=Pill-induced esophageal injury. Case reports and review of the medical literature |journal=Dig. Dis. Sci. |volume=28 |issue=2 |pages=174–82 |year=1983 |pmid=6825537 |doi= |url=}}</ref>
**Tetracycline
**[[Doxycycline]]
**Clindamycin
**Bisphosphonates
**Potassium chloride
**Quinidine preparations
**Iron compounds
**Emepronium
**Alprenolol
**Pinaverium 


* [[Infectious esophagitis]]<ref name="pmid247196002">{{cite journal| author=Wilcox CM| title=Overview of infectious esophagitis. | journal=Gastroenterol Hepatol (N Y) | year= 2013 | volume= 9 | issue= 8 | pages= 517-9 | pmid=24719600 | doi= | pmc=3980995 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24719600  }}</ref>
'''Complications of esophageal stricture dilation'''
:* [[Candida]]'' ''
:*      [[Herpes simplex virus (HSV)]]
:*      [[Cytomegalovirus|Cytomegalovirus (CMV)]]
:*      [[Human Immunodeficiency Virus (HIV)|Human immunodeficiency virus (HIV)]]


===Causes by Organ System===
'''Over time, the damage caused by stomach acid can scar the lining of the esophagus.When this scar tissue builds up, it makes the esophagus narrow. Called strictures, these narrow spots make it hard to swallow food and drinks, which can lead to weight lossand dehydration. medscape'''


{| style="width:80%; height:100px" border="1"
'''Refractory Esophageal Strictures: What To Do When Dilation Fails'''
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" |'''Cardiovascular'''
* https://www.uptodate.com/contents/esophageal-stricture-the-basics?source=search_result&search=esophageal+stricture&selectedTitle=4%7E137    for patient inforamtion
| style="width:75%" bgcolor="Beige" ; border="1" | No underlying causes
medscape:
|-
| bgcolor="LightSteelBlue" | '''Chemical/Poisoning'''
| bgcolor="Beige" |Caustic ingestion
|-
|- bgcolor="LightSteelBlue"
| '''Dental'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Dermatologic'''
| bgcolor="Beige" | [[Dyskeratosis congenita|Dyskeratosis congenita (DC)]], [[epidermolysis bullosa dystrophica]]
|-
|- bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| bgcolor="Beige" |Drug-induced stricture:
*Aspirin and anti-inflammatory agents
*Tetracycline
*Doxycycline
*Clindamycin
*Bisphosphonates
*Potassium chloride
*Quinidine preparations
*Iron compounds
*Emepronium
*Alprenolol
*Pinaverium 
|-
|- bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Endocrine'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Environmental'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| bgcolor="Beige" | Gastroesophageal reflux disease, [[Eosinophilic esophagitis]], Esophageal cancer, Esophageal diverticula , Hiatal hernia, Tracheoesophageal fistula
|-
|- bgcolor="LightSteelBlue"
| '''Genetic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Hematologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| bgcolor="Beige" | Previous surgery on the esophagus, Surgical anastomosis, Radiation therapy for thoracic or head and neck tumors, Esophageal sclerotherapy, Treatment for esophageal varices
|-
|- bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| bgcolor="Beige" |Infectious esophagitis
*''Candida'' 
*Herpes simplex virus (HSV)
*Cytomegalovirus (CMV)
*Human immunodeficiency virus (HIV)
|-
|- bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Neurologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Oncologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Psychiatric'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Pulmonary'''
| bgcolor="Beige" | Mediastinal fibrosis due to tuberclosis or idiopathic fibrosing mediastinitis, Tracheoesophageal fistula
|-
|- bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Sexual'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Trauma'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Urologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| bgcolor="Beige" | No underlying causes
|-
|}


===Causes in Alphabetical Order===
* Reinforce the need for patients with esophageal stricture to comply with the usual antireflux precautions and lifestyle modifications.
List the causes of the disease in alphabetical order.
* Encourage weight loss.
* Caustic ingestions
* Patients are told to eat smaller meals, avoid eating in a hurried fashion, and chew their food well.
 
* Ill-fitting dentures or poor dentition should be corrected if possible.
* Drug-induced stricture
* Educate all patients with esophageal stricture about avoiding medications known to cause esophagitis, including over-the-counter medications such as aspirin and nonsteroidal anti-inflammatory drugs.
* Dyskeratosis congenita (DC)
* Inform all patients that the stricture recurrence rate for esophageal stricture is higher if they are noncompliant with PPI therapy.
* Eosinophilic esophagitis
* For patient education resources, see  Heartburn and GERD Center and Digestive Disorders Center, as well as  Acid Reflux (GERD) and  Heartburn.
* Esophageal cancer
* Esophageal diverticula
* Esophageal sclerotherapy
* Gastroesophageal reflux disease
* Hiatal hernia
* Increased level of gastric acid exposure to esophageal tissue
* Infectious esophagitis
* Mediastinal fibrosis due to tuberclosis or idiopathic fibrosing mediastinitis
* Previous surgery on the esophagus
* Radiation therapy for thoracic or head and neck tumors
* Rare dermatologic diseases (eg, epidermolysis bullosa dystrophica)
* Surgical anastomosis
* Tracheoesophageal fistula
 
* Treatment for esophageal varices


==References==
==References==
{{Reflist|2}}
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{{WH}}
{{WS}}
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[[Category: (name of the system)]]
[[Category: (name of the system)]]

Latest revision as of 19:21, 9 November 2017


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahda Alihashemi M.D. [2]


Natural history and management of refractory benign esophageal strictures.

Natural history and management of refractory benign esophageal strictures

Peptic esophageal stricture: is surgery still necessary?

Predictor of massive bleeding following stent placement for malignant oesophageal stricture/fistulae: a multicentre study

Complications of esophageal stricture dilation

Over time, the damage caused by stomach acid can scar the lining of the esophagus.When this scar tissue builds up, it makes the esophagus narrow. Called strictures, these narrow spots make it hard to swallow food and drinks, which can lead to weight lossand dehydration. medscape

Refractory Esophageal Strictures: What To Do When Dilation Fails

medscape:

  • Reinforce the need for patients with esophageal stricture to comply with the usual antireflux precautions and lifestyle modifications.
  • Encourage weight loss.
  • Patients are told to eat smaller meals, avoid eating in a hurried fashion, and chew their food well.
  • Ill-fitting dentures or poor dentition should be corrected if possible.
  • Educate all patients with esophageal stricture about avoiding medications known to cause esophagitis, including over-the-counter medications such as aspirin and nonsteroidal anti-inflammatory drugs.
  • Inform all patients that the stricture recurrence rate for esophageal stricture is higher if they are noncompliant with PPI therapy.
  • For patient education resources, see  Heartburn and GERD Center and Digestive Disorders Center, as well as  Acid Reflux (GERD) and  Heartburn.

References

Template:WH Template:WS

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