The esophagus is described as a muscular tube that serves as a passageway for liquids and foods from the pharynx to the stomach.

Esophageal stricture is a narrowing of the lumen (the space within the tube) of the esophagus.

Obstructive or motor disorders cause interference with the passage of food or liquid through the esophagus resulting in dysphagia. Factors related to the major causes of the condition are as follows:

• Obstructive - Conditions such as cancer, esophageal ring, and adjacent large tumors that compress, or a benign narrowing in the stomach that prevents solids from passing into the stomach are classified as obstructive disorders.

• Motor - This dysfunction involves the smooth muscle of the esophagus. Solids and liquids are prevented from passing through due to interruption of peristalsis and lower esophageal sphincter function.

Strictures may be acquired, e.g., from infection, cancer, chemical irritation, trauma, or swallowing caustic liquids. Congenital causes of stricture may be an esophageal ring deformity, a vascular abnormality of the subclavian artery, or a membrane that grows across the esophagus (esophageal web). Vascular abnormalities of the subclavian artery are rare.

Inability of solids to pass down the esophagus occurs in obstructive disorders (see etiology). Dysphagia of both solids and liquids occurs in motor disorders. Thirty percent of people with dysphagia regurgitate undigested food at night. As a result, they may develop a lung abscess from aspiration, mild to moderate weight loss, and swallowing may bring on chest pain.

Diagnostic measures involve barium swallows and x-rays. Esophagoscopy is used to assist in diagnosing the extent and type of the stricture. If there is a suspicion of cancer, a biopsy is performed through the scope.

Initially, a forceful dilation of the sphincter is performed with a bougie. However, this procedure must be repeated often. Surgery and replacement of the injured esophagus with a piece of colon is done for strictures resulting from a corrosive ingestion. If stricture is mild, as in the esophageal ring condition, simply instructing the patient to chew food thoroughly will suffice. A blocking of the nerve supply of the lower esophagus with a direct injection of botulinum toxin has helped 70 to 80% of patients for 6 months to a year.

There has not been an ideal treatment devised yet for cure or relief of esophageal cancer.

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Notes

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