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| Stricture | ||
| Etiology •Strictures may be peptic, caustic, post radiation, inflammatory (non peptic) including infectious and congenital •The most common cause of stricture is post inflammatory narrowing •Multiple etiologies exist for irritation of the esophageal mucosa causing microscopic and clinical esophagitis •The most frequent are: peptic irritation (gastroesophageal reflux disease (GERD) or nonGERD); infectious (viral, fungal or bacterial); toxic (chemical); cytotoxic chemotherapy; irritants (alcohol, smoking, hot fluids and foodstuffs) | ||
| Pathogenesis •In the U.S. peptic irritation is the major cause and this involves exposure of epithelium to the caustic effect of gastric acid •An increasingly common occurrence is fungal or less commonly viral superinfection in an immunocomp[romised host either due to primary immunodeficiancy or secondary to chemotherapy •What ever the etiology of the esophagitis, stricture follows fibrous repair and is more likely to occur when significant necrosis or repeated episodes of esophagitis have occurred, | ||
| Epidemiology •Great variation in incidence of esophagitis exists geographically ranging from estimates of 5-10% in the U.S. to 80% in Iran •In the U.S. the primary cause is gastroesophageal reflux(GERD) while in France it is alcohol consumption and in Iran and the far east dietary | ||
| General Gross Description •Post inflammatory stricture can be focal or can involve a involve a longer segment of the esophagus •It is most commonly in the lower third often near the gastroesophageal junction consistent with its origin in GERD •The overlying mucosa may appear thin •The submucosa and muscularis are replaced by white rubbery firm tissue •The normal esophagus may also appear narrowed endoscopically, but advancing the endoscope will cause reflex relaxation of the esophageal musculature in the non-fibrotic esophagus but not in patients with fibrous stricture •Examples: | ||
| General Microscopic Description •Dense fibrous scar is seen replacing the submucosa and muscularis •The fibrous replacement of the wall is usually symmetrical •The overlying epithelium is often thin but shows no evidence of atypia •The epithelium may show evidence of active inflammation due to the antecedent esophagitis •Examples: | ||
| Clinical Correlation •Dysphagia is the primary symptom of stricture with a gradual increase in difficulty of swallowing •Treatment is establishment of an adequate lumen by progressive dilatation of the stricture •Recurrent dilatation is often necessary •Treatment of the primary cause of esophagitis should also be undertaken | ||
| References •It is best to refer to the primary cause of esophagitis in each particular case Please be patient during transfer. Medline will open in a new window. To return, close the Medline Window Stricture
| Synopsis by: Martin Nadel M.D. (T62000M34160)[377]
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