Esophagitis and Stricture

The esophagus is the food tube, or gullet, that carries food and liquid from the mouth to the stomach. The stomach churns the food and secretes a strong acid that aids in digestion. A specialized muscle, known as the lower esophageal sphincter (LES), is located at the end of the esophagus. This muscle normally contracts firmly, relaxing only to allow food and liquid to pass from the esophagus into the stomach. This muscle maintains a certain pressure to keep the end of the esophagus closed, preventing stomach acid and digested food from moving back into the esophagus.

What Is a Stricture?
The lower esophagus can open to the size of a quarter or wider. When recurrent inflammation occurs in the esophagus, scarring develops, underlying tissues become fibrous, and the opening narrows. In advanced cases, this narrowing, or stricture, can be severe. The opening may be reduced to the size of a pencil or even smaller. Food and fluid are delayed and only move slowly across the opening into the stomach. A large piece of food, such as meat, may completely block the esophagus. As mentioned, cancer can narrow the esophagus in the same way. Therefore, it is critical that the physician rule out this diagnosis.

Treatment
The physician can use a variety of methods to gently but forcefully open, or dilate, a stricture. Dilatation is often performed in conjunction with an upper endoscopy exam. one of the following dilatation methods may be used:

Bougie -- A series of increasingly larger, soft rubber or plastic dilators are moved across the stricture, gently opening it.

Guided wire -- A thin wire, placed across the stricture, is used to guide increasingly wider dilators over it.

Balloons -- Different types of sausage-shaped balloons can be placed across the stricture. The balloon is sharply inflated to open the narrowed area.

The physician chooses the type of dilatation that is most appropriate for each patient.

Are There Any Alternatives to Dilatation?
The only alternative to dilatation for opening a stricture is surgery. It is recommended only in the most extreme cases and when dilatation fails.

Complications
With dilatation, minimal bleeding almost always occurs, although it is rarely excessive or serious. A rare, but serious, complication is a perforation, or tearing, of the esophagus. This causes increasing pain after the procedure and may require surgery to correct.

Summary
Esophagitis usually can be treated easily with a conservative program of medical care. When scarring becomes severe, a stricture can occur. This condition can be treated by simple dilatation. While complications can occur, they are uncommon. Most patients obtain complete relief of their swallowing problems. By working with the physician, the correct program can be developed for each patient.