15 hours ago · An esophageal stricture refers to the abnormal narrowing of the esophageal lumen; it often presents as dysphagia, commonly described by patients as difficulty swallowing. It is a serious sequela to many different disease processes and underlying etiologies. Its recognition and management should be prompt. Stricture formation can be due to inflammation, fibrosis, … >> Go To The Portal
How is esophagitis diagnosed?Endoscopy: A long, flexible lighted tube called an endoscope is used to look at the esophagus.Biopsy: A small sample of the esophageal tissue is removed and sent to a laboratory to be examined under a microscope.More items...•
An esophageal stricture can be diagnosed on a barium swallow study and/or upper endoscopy (EGD). In general, an upper endoscopy is needed to confirm the diagnosis and evaluate for the cause of the stricture.
What are the symptoms of an esophageal stricture?Burning sensation in the neck or throat.Difficulty swallowing (dysphagia).Feeling of food getting stuck in your throat.Frequent episodes of choking.
Encourage small frequent meals of high calories and high protein foods. Small and frequent meals are easier to digest. Instruct to remain in upright position at least 2 hours after meals; avoiding eating 3 hours before bedtime. Helps control reflux and causes less irritation from reflux action into esophagus.
Esophageal dilation is the most recommended esophageal stricture treatment. The doctor uses a balloon or dilator — a long cylinder made of rubber or plastic — to widen the esophagus. The doctor gives you sedatives before the procedure to relax you and may numb parts of your throat, so you don't feel pain.
Medical Definition of stricture : an abnormal narrowing of a bodily passage (as from inflammation, cancer, or the formation of scar tissue) esophageal stricture also : the narrowed part.
A retrospective study of 55 patients with a benign esophageal stricture showed that in 11 patients (20%) the cause was a drug-induced lesion due to potassium chloride (3), tetracyclines (3), aspirin (2), vitamin C (1), phenytoin (1), and quinidine (1).
Benign esophageal stricture typically occurs when stomach acid and other irritants damage the lining of the esophagus over time. This leads to inflammation (esophagitis) and scar tissue, which causes the esophagus to narrow.
In achalasia, dysphagia usually occurs with both solid and liquid food, whereas in esophageal stricture and cancer, the dysphagia typically occurs only with solid food and not liquids, until very late in the progression of the stricture.
Patients with GERD can exhibit various symptoms, both typical and atypical. Typical symptoms include heartburn, regurgitation, and dysphagia. Atypical symptoms include noncardiac chest pain, asthma, pneumonia, hoarseness, and aspiration.
Nursing ManagementEat a low-fat, high-fiber diet.Avoid irritants, such as spicy or acidic foods, alcohol, caffeine, and tobacco, because they increase gastric acid production.Avoid food or drink 2 hours before bedtime or lying down after eating.Elevate the head of the bed on 6” to 8” bocks.Lose weight if necessary.
The treatment of GERD is primarily by medication with antacids, H2-receptor antagonists and PPIs, while surgery (typically with fundoplication) is used in selected patients.
This type of stricture is called a peptic stricture. Radiation therapy: Treatment for cancer in the head, neck or chest can cause strictures up to a year and a half later. Surgery: A procedure in the esophagus can leave inflammation and scarring, causing a stricture. Other causes: Ulcers, some medications (for example, ...
What is an esophageal stricture? An esophageal stricture is an abnormal tightening or narrowing of the esophagus. Your esophagus is a muscular tube that connects the throat to the stomach, carrying food and liquid. A stricture narrows the esophagus, making it more difficult for food to travel down the tube. In severe cases, even drinking liquid can ...
An esophageal constriction may cause: Burning sensation in the neck or throat. Difficulty swallowing (dysphagia). Feeling of food getting stuck in your throat. Frequent episodes of choking. Talk to a healthcare provider if you experience any of these symptoms. Strictures can lead to malnutrition and dehydration.
Esophageal dilation is the most common treatment for strictures. Your provider uses a balloon or dilator (a long plastic or rubber cylinder) to widen the narrow area of the esophagus.
Esophageal cancer: When abnormal cells divide or grow out of control in esophageal tissue, the tumor can cause strictures.
Complex strictures are longer and leave a narrower opening. They are not straight or symmetrical and have uneven surfaces and margins.
If you have a stricture, see a healthcare provider. They can determine how narrow your esophagus is and treat any underlying conditions, such as GERD.
The Esophageal stricture is a medical condition in which the esophagus narrows, a modification which leads to the appearance of certain symptoms, such as swallowing difficulties.
The causes that lead to the appearance of esophageal strictures can be classified into three main categories: Medical conditions in which the esophagus is narrowed by inflammatory processes, excess growth of fibrous tissue or cancerous growths. Medical conditions in which the esophagus is narrowed by the enlargement of the lymph nodes in the area. ...
Medical conditions in which the esophagus is narrowed by the enlargement of the lymph nodes in the area. Medical conditions in which the smooth muscles and the innervation of the esophagus are affected, with a negative effect on the peristalsis and overall functioning. These are the most common types of health problems that can cause ...
The incisions made at the level of the esophagus are followed by the usage of the Savary-Gilliard dilators
The usage of fluoroscopic guidance is optional. Available range varies between 5 and 20 mm. Disadvantages include: damage of the wall of the larynx, discomfort. Alternative – American dilators – advantages: shorter size, not so much tapered and they are coated with barium (allows for better guidance with the fluoroscope)
Indicated in strictures that have a diameter which goes over 1-1.2 cm
Idiopathic – increased levels of eosinophils. AIDS (acquired immunodeficiency syndrome) Reduced functioning of the immune system (such as the immunosuppression, which is characteristic for the patients who have received a transplant) Medication. NSAIDs.
An allergic condition called eosinophilic esophagitis. Cancer. Recent advancement in the use of endoscopic procedures for diagnostic as well as therapeutic purposes has increased the occurrence of iatrogenic post-procedural esophageal stricture formation resulting from mucosal injury.
Simple esophageal stricture is symmetric with a diameter of more than 12 mm. Simple strictures are usually under 2 cm in size, straight and allow easy passage for the endoscope.
Esophageal stricture is an abnormal narrowing of the esophagus (the tube from the mouth to the stomach). Esophageal stricture causes swallowing difficulties or dysphagia. People with esophageal strictures also have difficulty swallowing solid foods, but generally do not have problems with swallowing liquids. Swallowing problems may keep you from getting enough fluids and nutrients. Solid food, especially meat, can get stuck above the stricture. If this happens, endoscopy would be needed to remove the lodged food. There is also a higher risk of having food, fluid, or vomit enter the lungs with regurgitation. This can cause choking or aspiration pneumonia.
First, the size of the dilator that is going to be used is estimated endoscopically by assessing the diameter of the stricture area. The first dilation performed should be the same size as the stricture. It is advanced in increments. No excessive force is used. The majority of surgeons or endoscopists follow the “rule of three,” performing up to three dilations per session while successively increasing the diameter of the dilator by 2 mm (6Fr) 27). Use of fluoroscopy is controversial, but can certainly be helpful in complex strictures. It can play a contributory role based on the endoscopist’s experience 28).
After food is chewed and swallowed, the lump of food moves downward through the esophagus. If the esophagus is functioning normally, peristalsis, or a wave of coordinated contractions, takes place. Esophageal stricture formation is not common. One study reported an incidence rate of 1.1 per 10000 person-years, which also increases with age.
The normal esophagus measures up to 30 mm in diameter. A esophageal stricture can narrow this down to 13 mm or less, causing dysphagia. Esophageal stricture is a serious complication to many different disease processes and underlying causes.
Regardless of the nature of the esophageal stricture, patients typically present with one or all of the following symptoms: dysphagia (difficulty swallowing), food impaction, odynophagia (painful swallowing), chest pain, and weight loss 19). The most relevant symptom is progressive dysphagia to solid food, and this sometimes progresses to involve semisolid and liquid foods. The rate and type of symptom progression correlate with the underlying type of stricture. Physical examination findings are usually not significant in these patients.
Brachytherapy has been shown to be beneficial in patients with an expected survival of longer than 3 months with regard to (prolonged) dysphagia improvement, complications and quality of life. The mainstay of benign esophageal stricture treatment is dilation. Although dilation usually results in symptomatic relief, recurrent strictures do occur.
Esophageal strictures are a problem commonly encountered in gastroenterological practice and can be caused by malignant or benign lesions. Dysphagia is the symptom experienced by all patients, regardless of whether their strictures are caused by malignant or benign lesions.
Gastroesophageal is a portmanteau with “Gastro” meaning stomach and Esophagus. Reflux implies to return or flow back. Therefore, Gastroesophageal Reflux refers to the condition where stomach contents leak back into the esophagus. For a patient who has GERD, the sphincter weakens and relaxes but does not close properly.
NURSING ASSESSMENT FOR GASTROESOPHAGEAL REFLUX DISEASE (GERD) GERD is a long-term digestive disorder that affects the Lower Esophageal Sphincter (LES). The Lower Esophageal Sphincter is the ring of muscle between the stomach and the esophagus. Gastroesophageal is a portmanteau with “Gastro” meaning stomach and Esophagus.
Esophageal stricture- a situation whereby the esophagus narrows making swallowing hard and painful.
Lifestyle changes and diet changes include: Exercise to lose weight. Ensuring the baby burps after feeding while keeping them upright for 30 minutes after eating. Taking lots of fluids.
Treating some of the underlying factors like a hiatal hernia will help prevent the recurrence of GERD. Also taking doctor’s prescription or over the counter medications after diagnosis of any underlying condition will reduce the chances of GERD infection.
Medicines aimed at reducing the reflux and treat the damage to the esophagus lining due to the reflux acid; using proton pump inhibitors is the leading pharmaceutical treatment.
Other underlying factors include: Obesity. Stress. Certain medications are said to cause acid reflux like calcium channel blockers, sedatives or anti-depressants.
Malignant esophageal strictures result in rapid progression (ie, weeks to months) of severity and frequency of dysphagia and are associated frequently with significant weight loss.
Esophageal stricture. Endoscopic appearance of the distal esophagus showing a smooth stricture with a benign appearance.
Patients with adenocarcinoma of the gastroesophageal junction may have left supraclavicular lymphadenopathy (Virchow node).
Atypical presentations include chronic cough and asthma secondary to aspiration of food or acid.
The obstruction is usually perceived at a point that is either above or at the level of the lesion.
Dysphagia secondary to a Schatzki ring is usually intermittent and nonprogressive.
Approximately two thirds of patients with adenocarcinoma in Barrett esophagus have a history of long-standing heartburn.
These range from the minimally invasive (e.g. resection of stricture transgastrically with endoscopy assistance) 43 to the complex (e.g. colonic or jejunal interposition). 44 The patients who are most likely to require surgical intervention are those with complex and perhaps multiple strictures. Consequently, the most common surgeries for this indication are the most invasive. Of these, colonic interposition is associated with the fewest complications. 43
Self-expanding metal stents are commonly used for palliation in patients with malignant causes of dysphagia. They have improved the morbidity of esophageal stent insertion over that of the historically common rigid plastic stents. Metal stents, however, have some significant long-term complications, such as tumor ingrowth, stent migration and hyperplastic tissue reaction. The latter has been the most important limitation to these types of stents in benign strictures, as it impedes the removal of the stent.
Esophageal dilation does have associated risks. The purpose of dilation is disruption of tissue and this may result in mucosal tears and minor bleeding. Esophageal perforation is the most clinically important complication of esophageal dilation. The perforation rate has been reported to range between 0.1% to 0.4%. 20–23 In general, the risk of perforation is less for simple strictures than for complex strictures. There is no clear evidence of different perforation rates for mechanical versus balloon dilators. 15–17 One retrospective study demonstrated an increased perforation rate associated with blind passage of Maloney dilators versus Savary-Gillard and balloon dilators in patients with complex strictures. 20
If patients present initially with solid and liquid dysphagia, a motility disorder, rather than an anatomic abnormality, should be suspected. Other symptoms of esophageal stricture or narrowing include regurgitation or aspiration, chest pain, abdominal pain or weight loss. A detailed history of the patient’s symptoms can guide the clinician to the correct diagnosis in 80% of dysphagia cases. 1 While esophageal strictures are not the only cause of dysphagia, dysphagia is considered an ‘alarm’ symptom and should prompt further investigation.
It is generally accepted that mechanical dilators should be passed no more than three times for one dilation session (i.e. the famous ‘rule of three’) and that the goal should be to increase the lumen diameter by 2 mm. Though there is no consensus as to how much dilation is appropriate, it is generally accepted that the size of the lumen following the dilation that corresponds to symptom relief should be the goal. This number may be different for different patients. Typically a luminal diameter of 12 mm or larger is required to ameliorate symptoms of solid food dysphagia.
Benign stricture of the esophagus can have a severe and deleterious impact on quality of life for patients and can lead to important complications such as aspiration, weight loss and malnutrition. It is important that clinicians recognize the symptoms of esophageal stricture and institute the appropriate diagnostic and therapeutic interventions.
It has been shown that the injection of corticosteroids into the stricture may reduce stricture recurrence following dilation. This has been shown in patients who are undergoing dilation for the first time and in those in whom esophageal dilation has not resulted in symptomatic improvement, or who require frequent dilations, as well as for both short and long strictures. 35–38 Though the mechanism of action is not well defined, it is thought that corticosteroids may impede collagen deposition and enhance its breakdown locally, thereby reducing scar formation.