Stricture (narrowing) of the esophagus - as a complication of GERD

What is esophageal stricture

The esophagus is a long muscular tube that allows food to pass from the mouth to the stomach. An esophageal stricture is an area where the esophagus becomes too narrow. Food may get stuck in such areas. In such cases, swallowing food can be difficult and painful.

Often, narrowing of the esophagus appears against the background of scarring peptic ulcers of the esophagus and erosive-ulcerative reflux esophagitis. In these cases, they speak of esophageal stricture. A stricture is a clearly demarcated narrowing that does not expand under air pressure. In 70-73% of cases, esophageal strictures occur as a result of chemical burns of the esophagus.

In other cases, strictures develop as a result of reflux esophagitis, radiation therapy for thyroid cancer, or damage to the esophagus during surgery. Strictures develop if the muscular layer of the esophagus is affected. The degree of narrowing depends on the concentration of the solution, the extent of the lesion and the state of the immune system.

An esophageal stricture is an area where the esophagus becomes too narrow.

Strictures can be caused by constant reflux of gastric juice from the stomach into the esophagus, scarring of ulcers that form as a result, and damage to the walls of the esophagus. In addition, more rare but serious diseases, such as autoimmune diseases or tumors, can also cause a stricture. Treatment is mainly aimed at dilating the esophagus and treating the underlying disease.

At first you may feel discomfort when swallowing. However, if the stricture is not treated, it then progresses, and gradually the esophagus can become completely blocked. In this regard, swallowing food, even liquids, may become impossible.

People with esophageal strictures may also accidentally inhale food or drinks, leading to a lung infection. For the most part, surgery is not necessary and treatment is aimed at widening the esophagus. Anti-gastric acid medications are also often helpful during esophageal strictures. Sometimes, even after successful treatment, esophageal strictures recur.

A stricture of the esophagus, no matter what the cause, significantly reduces the patient’s standard of living, since the person loses the ability to eat properly, is subject to constant bouts of vomiting, and loses appetite and weight.

Symptoms of esophageal stricture

Esophageal stenosis begins with nonspecific signs of indigestion, usually heartburn and belching. As the disease progresses, problems with swallowing and chest pain when eating large amounts of solid food occur.

Expansion of esophageal stenosis by bougienage can be performed in all patients, regardless of the degree and extent of narrowing

Trying to protect himself from pain symptoms, a person begins to eat slowly, chewing food thoroughly, softening it with frequent drinking. Impaired passage of food to the stomach and intestines results in progressive malnutrition and the appearance of symptoms of deficiency of various microelements and vitamins.

Treatment of esophageal strictures

Expansion of esophageal stenosis by bougienage can be performed in all patients, regardless of the degree and extent of the narrowing. According to a number of researchers, balloon dilatation, like bougienage, can be used to treat any cicatricial strictures of the esophagus, including fairly long ones. Dilatation with balloon catheters is best used only in cases of short stenosis, when the lumen of the esophagus in the narrowing zone is at least 4-5 mm, which allows the balloon to be inserted into the stricture in a folded state.

Treatment with folk remedies is not recommended. The use of decoctions and tinctures brings relief for a short time, but does not stop the development of pathology and the appearance of complications.

Treatment, provided the changes are benign, with 1st and 2nd degree narrowing, occurs in adult patients using bougienage (insertion of tubes - bougies) into the esophagus or dilatation (stretching the organ with a special balloon). When the lumen of the esophagus is completely closed, when a person is not even able to swallow saliva, nutrition is administered intravenously.

Surgical treatment is performed if the pathology cannot be eliminated with a conservative option. Stenosis formed from scar tissue is subjected to endoscopic excision. In case of tumor strictures or compression from the outside, endoprosthetics of the esophagus is performed, and a special stent is inserted inside the lumen, which helps maintain the required dimensions of the organ.

A self-expanding stent is fixed into the lumen of the esophagus. Extended, pronounced, completely covering and re-forming narrowings require resection of the affected area, as well as esophagoplasty (replacement of the excised area with a gastric or intestinal graft). The overall prognosis after appropriately performed therapy is favorable, and relapses are rare.

Diagnostics

Esophageal stenosis is confirmed by a general examination and conversation with the patient. To determine the severity, position of the narrowings and their shape, additional examination methods will help.

1. Radiography. The simplest and cheapest method. Suitable for severe stages of stenosis, when the diagnosis is obvious and requires immediate treatment.
2. Computed and magnetic resonance imaging. They are especially suitable in the initial stages of the disease, in doubtful cases, for differentiation from pathologies of neighboring organs. They allow you to visualize the esophagus along its entire length and in all positions by making sections.
3. Endoscopy. Suitable for uncomplicated cases, since the method is quite dangerous: it can make things even worse due to damage from the endoscope.
4. Biopsy. Often, a narrowing of the esophagus is caused by a certain tumor that needs to be differentiated - it is cancer or a benign neoplasm, an ulcer or a defect in the muscular lining of the esophagus, etc. Using special clippers, the doctor takes a small portion of the area of ​​interest and sends it to a pathologist for microscopy. He studies the material and writes a conclusion. The scheme of further treatment and the prognosis for a person’s life and health in general depend on this.

Cicatricial strictures of the esophagus

Cicatricial strictures (narrowings) of the esophagus (ES) are a complication of acute and chronic inflammatory processes of the esophagus of various natures. Most often they develop as a result of corrosive esophagitis caused by a chemical burn, and reflux esophagitis caused by the reflux of aggressive gastric and/or intestinal contents against the background of failure of the esophageal-gastric closure mechanism. Postoperative strictures of the esophagus, or more precisely, esophageal anastomoses, are often observed.

Treatment of cicatricial strictures of the esophagus

Treatment of scar strictures of the esophagus begins with bougienage or dilatation of the esophagus and the goal is to stretch or rupture the scar tissue. Bougienage methods are currently varied.

Bougienage is usually carried out three times a week for 1.5-2 months, then once a week for 2-3 months, then the esophagus is bougienage once a month. Treatment takes a long time. If there is no effect of cicatricial strictures of the esophagus from the specified treatment, then esophageal plastic surgery is indicated.

Treatment

Barrett's syndrome requires timely therapy, which will help prevent the occurrence of malignant processes. Treatment is carried out using several methods:

1. Doctors use proton pump inhibitors.
2. Endoscopic method.
3. Surgical intervention. It is prescribed to patients if, after 3 months of conservative therapy, no positive dynamics are found. With increased suspicion of cancer or the presence of pathological malignant processes.

The prognosis for Barrett's esophagus will depend on the course of the disease, existing complications and concomitant pathologies. During treatment, the doctor recommends that his patients follow a diet, do not overeat, and avoid eating at night.

You should exclude foods that contain a lot of fat, caffeinated drinks, citrus fruits and fried foods from your diet. Barrett's syndrome does not allow the consumption of carbonated drinks, alcohol, or plant products.

Interesting! Pariet tablets: instructions for use of the medicine, analogues

Food is taken in small portions, 4 rubles. per day, after a meal it is recommended to walk in the fresh air for at least 30 minutes. It is necessary to eat foods that are richer in protein.

For information! Some experts suggest treating Barrett's esophagus with folk remedies. But before starting therapy, you should consult with your doctor.

Burn stricture of the esophagus

A burn stricture of the esophagus is a cicatricial narrowing of the esophagus, formed as a result of accidental or intentional ingestion of thermally (hot water, etc.) or chemically (acid, alkali, heavy metal salts, solvents) aggressive substances through the mouth.

Symptoms of burn scar stricture of the esophagus depend on the severity of damage to the esophagus.

The main symptom of burn stricture of the esophagus is dysphagia and difficulty swallowing

The main symptom of a burn stricture of the esophagus is dysphagia (difficulty swallowing), the degree of which most often correlates with the length and diameter of the narrowed section of the esophagus.

Impaired patency of the esophagus is accompanied by salivation, nausea and esophageal vomiting. Nutritional deficiency causes progressive weight loss in patients, which quickly leads to exhaustion of the body.

Treatment of burn strictures of the esophagus

There are two main methods of treating burn strictures of the esophagus - plastic surgery and bougienage of the esophagus. Bougienage of the esophagus as the initial (first) stage of treatment is carried out for all patients with burn strictures of the esophagus. High efficiency (85-90%) of this technique is achieved in the treatment of short strictures. In patients with extended strictures, bougienage provides adequate nutrition through the mouth at the preparatory stage for reconstructive surgery.

Surgical treatment is indicated for patients with extended burn strictures of the esophagus, combined burn damage to the pharynx and stomach, complete obliteration of the lumen and shortening of the esophagus, as well as in cases of impossibility or ineffectiveness of bougienage.

Esophagoplasty is performed either as a replacement of the esophagus, or bypassing the own esophagus as a bypass. In practice, transhiatal extirpation of the thoracic esophagus with one-stage plasty with an isoperistaltic gastric tube and retrosternal (bypass) antiperistaltic plasty of the esophagus with the left half of the colon have become widespread.

Post-burn scar strictures of the esophagus

Post-burn strictures have a significant extent and are often located in places of physiological narrowing of the esophagus. They can be single or multiple, complete or incomplete. The course of the stricture is often tortuous, the lumen is eccentrically located. With sharp narrowings, a suprastenotic dilatation of the esophagus occurs.

The main symptom of esophageal stricture is dysphagia, which appears from the 3-4th week from the onset of the disease. At first it is not clearly expressed. Over time, the narrowing progresses, the severity of dysphagia increases, and complete obstruction of the esophagus may develop. With high stenoses, food can enter the respiratory tract during swallowing, causing laryngospasm, bouts of painful coughing and suffocation.

One of the most common complications of cicatricial narrowing of the esophagus is a burn from hot food. Patients with stenosis often develop chronic inflammatory diseases of the bronchi and lungs due to regurgitation of food and its aspiration into the respiratory tract.

Treatment of post-burn scar strictures of the esophagus

The main method of treating esophageal stricture after a chemical burn is bougienage, which leads to a stable recovery in 90-95% of patients. Early bougienage (from 9-11 days after the burn) is preventive in nature. Later, bougienage is carried out in order to expand the already developed narrowing of the esophagus; it begins from the 7th week.

Bougienage is indicated for all patients with post-burn strictures of the esophagus. In front of it, a thin metal conductor is passed through the narrowing, through which a bougie is inserted, which reduces the risk of perforation of the esophagus. Contraindications are ongoing mediastinitis, bronchoesophageal fistula. To achieve a lasting clinical effect, treatment with bougienage must be carried out over many weeks and even months.

Peptic strictures of the esophagus, a complication of reflux esophagitis

Symptoms

Of all the manifestations, the following can be noted:

1. Heartburn or chest burning. Provoking factors are bad habits, food or physical activity.
2. Belching, which is accompanied by a sour taste in the mouth or bitterness. Disorders appear after severe physical exertion or poor nutrition.
3. Painful sensations.
4. Difficulty swallowing food.

One of the symptoms of Barrett's esophagus is hiccups because the phrenic nerve is irritated. Depending on the progression of the disease, the patient may develop iron deficiency anemia.

Peptic strictures of the esophagus

Peptic strictures of the esophagus are a complication of reflux esophagitis. In turn, reflux esophagitis is caused by various disorders of the closing apparatus of the esophageal-cardiac region, among which the most common is hiatal hernia.

In a number of patients, reflux esophagitis develops after operations on the esophagus and stomach. With a long course of esophagitis, the inflammatory process spreads to the muscle layer and even to the paraesophageal tissue with the formation of cicatricial strictures of the esophagus. In addition, a stricture may develop during healing of a peptic ulcer of the esophagus.

Typically, the formation of peptic cicatricial stricture of the esophagus is a rather long process, taking months and years. However, in some cases, peptic stricture of the esophagus develops rapidly; this occurs in patients who have undergone surgery on the abdominal organs with a severe, complicated course of the postoperative period.

Complications and prevention of esophageal stricture

Complications and consequences depend on the cause of esophageal obstruction:

• degeneration into a malignant tumor;
• formation of a hole in the wall of the esophagus;
• formation of ulcers (deep defects in the mucous membrane of the esophagus);
• the occurrence of bleeding from the esophagus;
• cachexia (extreme exhaustion).

Disease prevention comes down to preventing diseases and conditions that cause esophageal obstruction. Storing aggressive chemicals out of the reach of children, marking their packaging to avoid the possibility of confusing them with food products.

With concomitant gastroesophageal reflux disease (a disease characterized by the reflux of stomach contents into the esophagus), in order to exclude such a complication as esophageal stricture (narrowing of the esophagus due to the growth of scar tissue), the following rules must be followed - following a diet, avoiding overeating.

Refusal to lie down after eating. Normalization of body weight. Sleeping with the head end of the bed elevated. Refusal to wear tight clothes or tight belts. Elimination of active physical activity and work associated with bending forward.

Sources:

• https://studme.org/236286/meditsina/rubtsovye_striktury_pischevoda
• https://gastritinform.ru/medis.pp.ua/ru/bolezni/striktura-pisevoda
• https://03magadan.ru/ortopediya-i-travmatologiya/striktura-pishhevoda-prichiny-i-simptomy-vidy-i-stepeni-suzheniya-pishhevoda.html
• https://soundnes.ru/chto-takoe-striktura-pishchevoda-vsevozmozhnye-oslozhneniya-patologii-kuda/
• https://xn--b1adcb4becaobnxe0c.xn--p1ai/pages/left/pischevod/hirurgiya_pischevoda_obschaya/5/
• https://studopedia.org/6-118118.html
• https://lookmedbook.ru/disease/neprohodimost-pischevoda-