In this post I will concentrate on benign strictures. The majority of benign strictures (95%) are as a result of acid reflux from the stomach into the esophagus. A stricture of the esophagus is a narrowing of the esophagus. This results in a difficulty when swallowing.

Patients will point to where the stricture is localised but this is no guide. One of my patients pointed to the throat when on endoscopy the problem was lower down at the gastro-esophageal junction which is under the diaphragm.

Benign strictures although distressing, in that swallowing is a real problem, is not considered a serious problem as it does not lead on to life threatening situations. Hence the name benign.

Acid reflux makes up the bulk of strictures and it is therefore imperative that you follow recommended protocol on acid reflux treatment to avoid this unpleasant complication developing. I have seen patients develop high levels of stress following  strictures.

Benign strictures can follow surgical procedures but this is uncommon today. Radiotherapy for tumours near to the esophagus such as lung cancer and breast tumours can result in damage to the esophagus and resultant stenosis.

Accidental ingestion of corrosive compounds such as bleach will significantly burn the lining of the esophagus. Subsequent healing will leave scarring and strictures.

Some drugs can also be corrosive. One, not used as extensively now, is slow release potassium. In addition research has shown that there is a higher incidence of strictures in patients on regular NSAIDs. How significant this is to the overall treatment of acid reflux is unclear.

A stricture will result in dysphagia. This is difficulty in swallowing. As said earlier the area the patient complain the problem is located bears no accurate indication as to where the problem is. Some patients can swallow liquids and not solids

All dysphagia needs further investigation. Weight loss or anaemia in the presence of stricture warrants greater urgency. At endoscopy the severity of restriction can be assessed and a biopsy taken for accurate diagnosis.

Treatment of benign strictures are usually done today by endoscopic dilatation in outpatients clinics. This is likely to be repeated if the stricture returns. Usually patients with strictures have two to three endoscopic dilatations. If the stricture returns very quickly then this may suggest some underlying sinister disease and you need to see your gastro-enterologist very soon.

Patients with recurring strictures are maintained on omperazole or other proton pump inhibitors as treatment of acid reflux to prevent further esophagitis.

Dr. Phil Hariram,