Why does the esophagus narrow?
The lining of the esophagus is not as protected from acid as the lining of the stomach. With prolonged reflux of stomach contents, inflammation and ulcers occur, and then in their place scar tissue grows, which tightens the wall. This option is called peptic stricture and is the most common. The second common cause is a chemical burn after accidental or intentional ingestion of acid or alkali: the scars in this case are extensive and dense. Tumor, the effects of radiation therapy, damage from pills, and eosinophilic esophagitis can also narrow the lumen.
- Peptic stricture due to reflux disease
- Chemical burn from acid or alkali
- Esophageal tumor or external compression
- Effects of radiation therapy on the chest area
- Eosinophilic esophagitis
- Scars after operations and endoscopic interventions
- Damage to the mucous membrane from tablets taken without water
Symptoms
Dysphagia with a benign stricture increases slowly, over months. First, a person notices that meat and dry bread go worse, and begins to chew and drink more thoroughly. Later, there is a feeling of a lump and pressure behind the sternum, and sometimes pain. With pronounced narrowing, food is retained and returned undigested, along with saliva. A dangerous consequence is food entering the respiratory tract, causing coughing and the risk of pneumonia. Weight gradually decreases.
- Difficulty swallowing solid foods
- Feeling of food stopping behind the sternum
- The need to wash down every bite
- Regurgitation of undigested food
- Chest pain when swallowing
- Coughing and choking while eating
- Weight loss
Diagnostics
The main method is endoscopy: the doctor sees the level and degree of narrowing, the condition of the mucosa and always takes a biopsy to exclude a malignant tumor and eosinophilic esophagitis. X-ray of the esophagus with contrast clearly shows the extent of the narrowing and the shape of the esophagus above it, especially if the endoscope does not pass through. Computed tomography is prescribed if a tumor or external compression is suspected. Additionally, anemia and protein levels are assessed, since prolonged malnutrition depletes the body.
- Endoscopy of the esophagus with biopsy
- X-ray of the esophagus with contrast
- Computed tomography for suspected tumor
- Complete blood count, albumin, iron
- Esophageal manometry for suspected motility disorders
Treatment
The main method is endoscopic expansion of the narrowed area with bougies or a balloon. The procedure often has to be repeated several times at intervals, gradually increasing the diameter. At the same time, the cause is eliminated: for peptic stricture, long-term use of proton pump inhibitors is prescribed, without which the narrowing quickly returns. For eosinophilic esophagitis, the underlying disease is treated; for a tumor, surgical or combined treatment is chosen, and sometimes a stent is installed. Surgery is used for extended scars that cannot be expanded. The doctor determines the tactics.
- Bougienage or balloon dilatation
- Long-term therapy with proton pump inhibitors
- Treatment of the underlying disease
- Installation of a stent for tumor narrowing
- Reconstructive surgery for extended scars
- Eating soft, crushed food during treatment
Nutrition and prevention
While the lumen is narrowed, it is important not to starve or allow food to get stuck. The food is crushed, soft dishes are prepared, eaten in small portions, chewed slowly and thoroughly, while sitting upright. Avoid large pieces of meat, dry bread, and nuts. Prevention of peptic strictures - timely treatment of reflux disease: do not tolerate heartburn for years, do not eat it with soda, get examined if you have long-term symptoms. The tablets should always be taken with a full glass of water and should not be taken lying down. Chemicals are stored separately from products and out of the reach of children.
- Soft, crushed food in small portions
- Chewing thoroughly and eating without haste
- Do not eat lying down and do not lie down immediately after eating
- Treatment of reflux disease with a doctor
- Take the tablets with a full glass of water
- Safe storage of household chemicals
