Current management of benign oesophageal strictures

Benign reflux strictures most commonly result from gastro-oesophageal reflux but other causes must be excluded. Ambulatory pH monitoring is useful to confirm and quantitate the severity of reflux. Reflux strictures can be managed by dilatation and vigorous continued antireflux treatment but surgery offers a safe and more effective means of correcting the physiological dysfunction of the sphincter. Healthy patients should, therefore, be offered a permanent cure by surgery and conservative measures should be reserved for patients who are elderly, obese or unfit for surgical management. Before starting surgical treatment a full investigation is mandatory. Radiological, endoscopic, histological and cytological studies, pH monitoring, motility evaluation of the motor power of the oesophagus and sphincter and an assessment of gastric emptying are all necessary investigations for a complete evaluation of the dysfunction and effective surgical planning.