Diagnosis and management of peptic esophageal strictures

Peptic strictures of the esophagus are a common sequelae of long-standing reflux esophagitis. They occur in approximately 10% of patients with gastroesophageal reflux disease seeking medical evaluation. Factors predisposing to stricture formation are poorly understood; however, stricture patients are typically older, have a longer duration of reflux symptoms, and more frequently display abnormal esophageal motility than reflux patients without strictures. Diagnosis can usually be made with a careful history but should be confirmed with a barium esophagram followed by endoscopy with biopsies to exclude malignancy. Relief of dysphagia, which is the initial goal of therapy, can be readily accomplished in most patients using polyethylene or mercury-filled dilators or balloons. An equally important therapeutic objective should be the complete healing of associated esophagitis using proton pump inhibitors. Surgical treatment is reserved for the subset of patients with intractable esophagitis, irreversibly damaged esophagus, or extraesophageal manifestations.