Peptic Strictures

What Are Peptic Strictures?

Strictures are the result of a healing process in ulcerative esophagitis. Collagen is deposited during this phase and with time, the collagen fibers contract causing narrowing of the esophageal lumen. These strictures are usually short in length and are closely situated to the gastroesophageal junction. The main symptom is dysphagia, or difficulty swallowing, for solid food. In some cases, peptic stricture can cause an esophageal obstruction or food impaction.

 

Treatment

Dramatic relief of dysphagia and peptic strictures can be obtained by mechanical dilation with mercury- filled, rounded, or tapered dilators. This generally requires dilation to a lumen diameter of greater than 14 mm. Unyielding, tortuous or tight strictures may require an endoscopically positioned balloon dilator or a dilator passed over an endoscopically placed metal wire guide.

 

Severe strictures invariably require several dilations. The schedule for serial dilation should be based on the type of stricture, its response to initial and subsequent dilation, and the patient’s tolerance of the procedure. Treatment with a proton pump inhibitor (Prilosec, Prevacid, Aciphex, Nexium, Protonix) can prevent recurrence of strictures once they have been adequately dilated. The benefit is greater than that achieved with H2 blockers (Zantac, Pepcid, Tagamet, and Axid). Obviously, one should follow the recommendations of a typical heartburn diet. These are to avoid food and beverages that contribute to heartburn, such as chocolate, coffee, peppermint, greasy or spicy foods, tomato products, and alcohol. Reduce weight if you are too heavy. Do not eat two to three hours before bedtime. Stop smoking as Tobacco inhibits saliva, which is the body’s major buffer. Tobacco may also stimulate stomach acid production and relax the muscle between the esophagus and the stomach, allowing acid reflux to occur.

 

How Is Dilation Performed?

Esophageal dilation is usually performed after examining the esophagus with an endoscope. This is necessary so .that the problem can be clearly assesed and any serious conditions, such as cancer, can be excluded.

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