An esophageal stricture is a narrowing of the esophagus, most often from scarring after long-term acid reflux. Food gets stuck as the narrowing worsens, and the main treatment is stretching it during endoscopy.
Key symptoms
- Slowly worsening trouble swallowing solid foods
- Food feeling stuck behind the breastbone
- Long history of heartburn
- Weight loss in long-standing cases
What you find on exam
- Often a normal exam
- Weight and nutrition status
- Watch the patient swallow water
- Neck exam for masses or lymph nodes
Tests
- Upper endoscopy with biopsy to find the cause and rule out cancer
- Barium swallow to map a complex or long stricture
- Biopsies for eosinophilic esophagitis when relevant
- Blood count and albumin if there is weight loss
Treatment basics
- Endoscopic dilation with a balloon or bougie
- Proton pump inhibitor such as omeprazole to prevent recurrence
- Eat slowly, cut food into small pieces and chew well
- Repeat dilation as needed for recurrent narrowing
Red flags
- Food stuck with inability to swallow saliva
- Unexplained weight loss or progressive symptoms in an older adult
- Vomiting blood or black stools
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.