Peptic strictures of the esophagus

Peptic esophageal strictures are a common sequelae of long-standing reflux esophagitis. Factors predisposing to stricture formation are poorly understood; however, stricture patients are typically older, have a longer duration of reflux symptoms, have significantly lower lower esophageal sphincter pressures, and more frequently display abnormal esophageal motility than reflux patients without strictures. A careful history should suggest the diagnosis in most cases, but should be confirmed with a barium esophagram followed by endoscopy with biopsies to exclude malignancy. The therapeutic armamentarium for treating peptic strictures has greatly expanded during the past 30 yr. It now includes potent anti-secretory medications, bougienage with flexible polyethylene dilators or balloons, and anti-reflux surgery. Aggressive medical therapy combined with bougienage is safe and effective treatment for the majority of stricture patients, with surgery being reserved for the subset of patients with intractable esophagitis, irreversibly damaged esophagus, or extra-esophageal manifestations.