What Causes The Oesophagus To Narrow?

Introduction

Oesophageal stricture is the abnormal narrowing or tightening of your oesophagus. It is a rare condition that can affect people of all ages, although more prevalent in those aged 40 and over. Your oesophagus is a muscular tube through which food or liquid passes from your mouth to the stomach. People with oesophageal strictures may find it painful or difficult to swallow.² It is most commonly associated with Gastro-oesophageal reflux disease (GORD). Oesophageal stricture is diagnosed in around 10% of patients with GORD. This is a condition where stomach acid leaks into the oesophagus, resulting in inflammation. Eventually, this inflammation can cause scarring, leading to the oesophagus’s narrowing.¹

However, it can also result from other medical conditions such as cancer, eosinophilic esophagitis and the accidental ingestion of chemicals. Additionally, strictures can form after oesophageal surgery or treatments such as laser therapy.² 

Oesophageal strictures can be:

• Cancerous – these strictures quickly progress and are more severe
• Benign (non-cancerous) – these tend to progress much more slowly

In most cases, strictures are treated with a dilation process, which widens the oesophagus and helps to relieve the symptoms associated with the condition.² 

Types of oesophageal strictures

Oesophageal strictures can be categorised into two groups:³ 

• Simple strictures: They are straight, symmetrical and have smooth surfaces 
• Complex strictures: They are longer and leave a narrower opening. They are not straight or symmetrical and are found to have uneven surfaces 

Causes of oesophageal strictures

Oesophageal stricture can be caused by:²

• Swallowing of corrosive substances such as household cleaning products. This can cause mild to severe damage to the oesophagus
• Medication-induced strictures: Use of medications such as potassium chloride tablets, tetracycline antibiotics, and NSAIDs can cause esophagitis, and long-term use can result in strictures
• Eosinophilic esophagitis: An allergic condition which causes inflammation in your oesophagus that can lead to strictures
• Oesophageal Cancer: When cells in the oesophagus start to divide abnormally and develop into tumours it can lead to strictures
• Use of a nasogastric tube over an extended period

Risk factors for oesophageal strictures

Risk factors that can increase your chances of developing oesophageal strictures may include:

• Alcohol consumption
• Cancer in the neck region
• GORD
• Hiatal hernia
• Peptic ulcer disease
• A history of dysphagia  

Symptoms of oesophageal strictures

Symptoms you might experience if you have oesophageal stricture include:

• Dysphagia (difficulty swallowing)
• Chest pain
• Food sticks in your throat
• Burning sensation in your neck or throat
• Frequent bouts of choking

Diagnosis of oesophagus stricture

If you are suffering from oesophageal stricture, it is important to seek medical attention as strictures can result in malnourishment as well as dehydration. Your GP may refer you to a specialist for diagnosis.

Some of the diagnostic tests for oesophageal strictures are:²

• Upper gastrointestinal endoscopy: It is a procedure often utilised by clinicians to view the inside of the oesophagus. It is also known as gastroscopy. There is a procedure called an upper gastrointestinal endoscopy which allows clinicians to view your oesophagus and access scarring or inflammation that may be present. If strictures are detected, then a small sample of the tissue (biopsy) is collected to rule out cancer
• Barium Swallow Test (Oesophagram): It is a procedure where you will swallow a solution with barium. As the barium travels down the oesophagus it highlights the affected parts of the oesophagus and an X-ray is conducted to view this
• Oesophageal manometry: In this procedure, a small catheter tube will be inserted through your nose and into the oesophagus to examine the sphincter and oesophageal muscles
• Endoscopic ultrasound: This procedure helps the clinician to measure how thick the oesophageal wall has become and how obstructed the oesophagus is

Getting an accurate diagnosis is important as the cause of the stricture will decide the treatment you receive. 

Treatment for oesophageal strictures

The most common treatment option for strictures is oesophageal dilation.

Oesophageal dilation is the most common treatment option for strictures. Under sedation or general anaesthesia, a doctor will insert an endoscope into your oesophagus. Once they reach the strictured site they will insert a balloon to dilate the area. They might also use rubber or plastic dilators of bigger sizes to stretch the area. In some cases, complex strictures may require metal oesophageal stents to open the strictured area.⁴ 

Prevention of oesophageal strictures

You can prevent oesophageal strictures by effectively managing your GORD symptoms both with dietary and lifestyle choices but also by taking your prescribed medicines. 

Lifestyle changes you can introduce include:

• Stop smoking
• Lose weight, if obesity is contributing to GORD
• Prop yourself up at night to prevent stomach acid from flowing into your oesophagus while you are sleeping.
• Reduce foods that might be contributing to acid reflux such as spicy foods, chocolate, coffee etc.
• Limit your alcohol intake

It is also important to protect your children by keeping corrosive substances, such as lithium batteries out of reach.

Summary

Oesophageal stricture is the abnormal narrowing of the oesophagus with the most common cause being GORD. People with oesophageal strictures may find it painful or difficult to swallow and this can result in dehydration or malnourishment if the oesophageal stricture is not treated. The most common treatment for oesophageal strictures is to undergo a dilation process this widens the strictured site and helps to relieve the associated symptoms. If you experience any of the symptoms please contact your healthcare provider immediately.