Esophageal stricture
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Oesophageal strictures refer to any persistent intrinsic narrowing of the oesophagus.
Pathology
Aetiology
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
- pemphigoid
- 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:
- scleroderma
- prolonged nasogastric intubation
- Zollinger-Ellison syndrome: high acidity reflux
- post partial or total gastrectomy: alkaline
refluxreflux- performing the roux-en-Y procedure may avoid this, by diverting the pancreatic secretions and bile away from the gastric remnant
Radiographic features
Benign strictures typically show :
- smoothly tapering
, -
typically concentric narrowing
., but may affect only one side of the oesophagus (asymmetric wall rigidity)
Malignant strictures are characteristically
- abrupt
, - asymmetric
, - eccentric
narrowingswith 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.
-<p><strong>Oesophageal strictures</strong> refer to any persistent intrinsic narrowing of the <a href="/articles/oesophagus_(textbook)">oesophagus</a>. </p><h4>Pathology</h4><h5>Aetiology</h5><p>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. </p><p><strong>Upper and middle oesophageal strictures</strong> most commonly result from </p><ul>- +<p><strong>Oesophageal strictures</strong> refer to any persistent intrinsic narrowing of the <a title="oesophagus" href="/articles/oesophagus_(textbook)">oesophagus</a>. </p><h4>Pathology</h4><h5>Aetiology</h5><p>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. </p><p><strong>Upper and middle oesophageal strictures</strong> most commonly result from </p><ul>
-</ul><p><strong>Distal oesophageal strictures</strong> are caused by <a href="/articles/gastro-oesophageal-reflux-disease">gastro-oesophageal reflux disease (GORD)</a>, either as a separate entity, or in the setting of:</p><ul>-<li><a href="/articles/gastrointestinal-manifestations-of-scleroderma">scleroderma</a></li>- +</ul><p><strong>Distal oesophageal strictures</strong> are typically caused by <a href="/articles/gastro-oesophageal-reflux-disease">gastro-oesophageal reflux disease (GORD)</a>, either as a separate entity, or in the setting of:</p><ul>
- +<li><a href="/articles/scleroderma-gastrointestinal-manifestations">scleroderma</a></li>
-<li>post partial or total gastrectomy: alkaline reflux<ul><li>performing the <a href="/articles/roux-en-y-procedure">roux-en-Y procedure</a> may avoid this, by diverting the pancreatic secretions and bile away from the gastric remnant</li></ul>- +<li>post partial or total gastrectomy: alkaline reflux<ul><li>performing the <a href="/articles/roux-en-y-procedure">roux-en-Y procedure</a> may avoid this, by diverting the pancreatic secretions and bile away from the gastric remnant</li></ul>
-</ul><h4>Radiographic features</h4><p>Benign strictures typically show smoothly tapering, concentric narrowing. Malignant strictures are characteristically abrupt, asymmetric, eccentric narrowings with irregular, nodular mucosa. Tapered margins may occur with malignant lesions because of the ease of submucosal spread of tumour.</p>- +</ul><h4>Radiographic features</h4><p>Benign strictures: </p><ul>
- +<li>smoothly tapering</li>
- +<li>typically concentric narrowing, but may affect only one side of the oesophagus (asymmetric wall rigidity)</li>
- +</ul><p>Malignant strictures are characteristically</p><ul>
- +<li>abrupt</li>
- +<li>asymmetric</li>
- +<li>eccentric with irregular, nodular mucosa</li>
- +</ul><p>Tapered margins may occur with malignant lesions because of the ease of submucosal spread of tumour.</p><p>Oesophageal strictures are often associated with a <a href="/articles/hiatus-hernia">hiatal hernia</a>.</p><h4>Treatment and prognosis</h4><p>The risk of <a href="/articles/barrett-oesophagus">Barrett oesophagus</a> in a stricture is 20-40% and strictures should be evaluated endoscopically.</p>
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