Diagnosis
Esophageal stricture
An abnormal narrowing of the esophageal lumen.
Also known as: Esophageal stenosis
Etiology
Cause [c8t]
Inflammation: [wic]
Gastroesophageal reflux (Acid) 75% [uzt]
Autoimmune: Eosinophilic esophagitis [rec], Graft versus host disease, SLE, rheumatoid arthritis, Crohn disease
Radiation therapy
Thermal Injury: coffee or tea
Infection: Candida, herpes simplex virus, CMV, HIV, Tuberculosis
Sclerotherapy: Corrosive substance ingestion
Drug-induced esophagitis: Alendronate, ferrous sulfate, NSAIDs, phenytoin, potassium chloride, quinidine, tetracycline, ascorbic acid
Cancer: Esophageal adenocarcinoma/squamous cell carcinoma, metastatic lung cancer
Extrinsic compression
Iatrogenic: Endoscopic submucosal dissection, postoperative anastomotic stricture
Foreign body
Congenital esophageal stenosis
Skin disease: Pemphigus vulgaris, benign mucous membrane pemphigoid, epidermolysis bullosa dystrophica, scleroderma, SLE
Other: Chemotherapy, Plummer-Vinson syndrome, prolonged use of nasogastric tube
Pathophysiology [c8t]
Normal esophagus: 30 mm in diameter
Stricture: <13 mm --> dysphagia
Chronic inflammation --> intramural fibrosis and scarring --> luminal constriction
Malignant stricture: proliferation and invasion of cancer cells from the luminal mucosa
Complications [c8t]
Food impaction
Aspiration pneumonia
Severe chest pain
Esophageal perforation
Fistula formation
Treatment complications: perforation, hemorrhage, bacteremia
Epidemiology
Incidence per 100.000 [4ud][scr][uzt][cqb]
Symptoms & findings
Symptoms
Cough, Dysphagia, Globus sensation, Heartburn, Odynophagia
Clinical findings
Gastroesophageal Reflux Disease, Gastrointestinal obstruction
Anamneses
None listed.
Localized findings
Approach
Barium enema
Gastroscopy
Chest radiography
CT thorax
Endoscopic ultrasound
Esophageal pH monitoring
Esophageal manometry
Biopsy
Treatment
Diet: [wic]
Avoid fatty and spicy foods, alcohol, tobacco, chocolate, and peppermint
Eat smaller meals, avoid eating in a hurried fashion, and chew their food well
Do not to eat at least 2-3 hours before bedtime
Aggressive acid suppression using PPIs
Endoscopic dilation
Intralesional steroid injection
Endoscopic stricturoplasty
Endoscopic stent
Open surgical resection (usually only an option if cancer)
Differential diagnoses
Achalasia, Eosinophilic esophagitis, Esophageal cancer, Esophageal hiatal hernia, Esophageal spasm, Esophagitis, Gastroesophageal reflux disease, Ulcer disease
References
[1] Desai JP, Moustarah F. Esophageal Stricture. [Updated 2023 May 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542209/
[2] https://emedicine.medscape.com/article/175098
[3] Fennerty MB. The continuum of GERD complications. Cleve Clin J Med. 2003 Nov;70 Suppl 5:S33-50.
[4] Vijayalakshmi K, Gunasekaran TS, Hussain K, Patton T, Li Y, et al. Risk factors for esophageal strictures in children and adolescents with eosinophilic esophagitis. J Adv Pediatr Child Health. 2022; 5: 033-038.
[5] Ruigómez A, García Rodríguez LA, Wallander MA, Johansson S, Eklund S. Esophageal stricture: incidence, treatment patterns, and recurrence rate. Am J Gastroenterol. 2006 Dec;101(12):2685-92.
[6] Wong WM, Lam SK, Hui WM, Lai KC, Chan CK, Hu WH, Xia HH, Hui CK, Yuen MF, Chan AO, Wong BC. Long-term prospective follow-up of endoscopic oesophagitis in southern Chinese--prevalence and spectrum of the disease. Aliment Pharmacol Ther. 2002 Dec;16(12):2037-42.
[7] Xue AZ, Anderson C, Cotton CC, Gaber CE, Feltner C, Dellon ES. Prevalence and Costs of Esophageal Strictures in the United States. Clin Gastroenterol Hepatol. 2024 Apr 6:S1542-3565(24)00308-2.