OESOPHAGEAL STRICTURES
Oesophageal strictures can be divided into:
- II) Strictures secondary to esophagitis and reflux.
1. Caustic strictures
- Aetiology: Ingestion of caustic agents such as dye, drain openers, acids.
Diagnosis:
- History of ingestion.
- Symptoms: Shock, burning sensation.
- Endoscopy to determine the damage.
Treatment:
- Medical:
- Neutralizing agent.
- Corticosteroids and broad-spectrum antibiotics for 3-6 weeks.
- Barium swallow of the oesophagus performed after 10-14 days to determine development of stricture.
- Surgical:
- Dilatation of stricture if present.
- Oesophageal replacement surgery with colon or stomach may be necessary.
2. Secondary strictures to esophagitis and reflux:
Pathophysiology:
- Usually at gastro-oesophageal junction.
- In severe cases long stricture may result.
Diagnosis:
- History of reflux symptoms and dysphagia is suggestive of strictures.
- Barium swallow of the oesophagus confirms the diagnosis.
- Fibre-optic upper GI endoscopy done to locate the site of the stricture and take a biopsy if required.
- Rigid oesophagoscopy is important to determine the extent of disease,rule out malignancy and take a biopsy if required.
Treatment:
- Dilatation of the oesophagus by fibre optic oesophagoscopy is attempted first and anti-reflux operation is performed.
- Reconstructive surgery using stomach or colon.
