Oesophageal strictures refer to any persistent intrinsic narrowing of the oesophagus.
The most common causes are fibrosis induced by inflammatory and neoplastic processes. Because radiographic findings are not reliable in differentiating benign from malignant strictures, all should be evaluated endoscopically.
Upper and middle oesophageal strictures most commonly result from
- Barrett oesophagus
- mediastinal radiation
- caustic ingestion
- congenital oesophageal stenosis
- oesophageal intramural pseudodiverticulosis
- skin diseases associated with mucosal ulceration, such as
- erythema multiforme
- epidermolysis bullosa dystrophica
Distal oesophageal strictures are typically caused by gastro-oesophageal reflux disease (GORD), either as a separate entity, or in the setting of:
- prolonged nasogastric intubation
- Zollinger-Ellison syndrome: high acidity reflux
- post partial or total gastrectomy: alkaline reflux
- performing the roux-en-Y procedure may avoid this, by diverting the pancreatic secretions and bile away from the gastric remnant
- smoothly tapering
- typically concentric narrowing, but may affect only one side of the oesophagus (asymmetric wall rigidity)
Malignant strictures are characteristically
- eccentric with irregular, nodular mucosa
Tapered margins may occur with malignant lesions because of the ease of submucosal spread of tumour.
Oesophageal strictures are often associated with a hiatal hernia.
Treatment and prognosis
The risk of Barrett oesophagus in a stricture is 20-40% and strictures should be evaluated endoscopically.
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- 2 Karasick S, Lev-toaff AS. Esophageal strictures: findings on barium radiographs. AJR Am J Roentgenol. 1995;165 (3): 561-5. AJR Am J Roentgenol (abstract) - Pubmed citation
- 3. Luedtke P, Levine MS, Rubesin SE et-al. Radiologic diagnosis of benign esophageal strictures: a pattern approach. Radiographics. 23 (4): 897-909. doi:10.1148/rg.234025717 - Pubmed citation