Peptic Esophageal Stricture: Medical Treatment

Abstract

Peptic esophageal stricture as a consequence of gastroesophageal reflux disease is the most frequent among benign esophageal strictures. The incidence is low and has been decreasing since the 1990s with a parallel increase in proton pump inhibitor use. Dysphagia is a common symptom: accurate diagnostic procedures (barium esophagogram, upper endoscopy with biopsies) have to be performed to exclude malignant causes first. Medical (acid-suppressive) therapy, endoscopic dilation and surgical intervention are the main therapeutic options. Based on the results of randomized and observational studies evaluating the effect of acid-suppressive therapy on peptic stricture outcome, healing the coexistent esophagitis seems to be essential. Effective acid-suppressive therapy with proton pump inhibitors may reduce the need for repeated dilations and provide symptom relief and better clinical outcome. In refractory strictures, local steroid injection is likely beneficial.

Inflammatory mediators in gastroesophageal reflux disease: impact on esophageal motility, fibrosis, and carcinogenesis

“…Up to 70% of all benign esophageal strictures in the US were caused by reflux disease (74,96). With the emergence of PPIs in the 1990s, the incidence of esophageal strictures decreased dramatically (26,107).…”

“…The pathophysiology of fibrosis in the esophagus is unclear (96,101). It is believed that fibrosis develops after epithelial injury, causing proliferation and activation of resident fibroblasts and deposition of ECM, as a response to tissue damage caused by acid peptic injury.…”

Prophylactic Treatment with Proton Pump Inhibitors in Children Operated on for Oesophageal Atresia

“…Recent epidemiological data have indicated that treatment with PPI is effective in prevention of oesophageal peptic strictures in general when treated with PPI for a period of at least 3 months [2,3]. In patients with peptic oesophageal strictures the healing of coexisting esophagitis is crucial and PPI treatment has been suggested to reduce dilatation frequency and to provide symptom relief [4].…”

Association of Gastro-Oesophageal Reflux Disease with Oesophageal Stricture: What can be Done to Prevent It

“…In Europe and North America, benign OS is commonly caused by recurrent peptic and to a lesser degree by non-peptic pathology such as corrosive injury, eosinophilicoesophagitis, post-surgery, and trauma [9,10]. In this cohort of patients, GORD was the main associated risk factor for benign OS.…”