Esophageal stricture pathophysiology: Difference between revisions

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{{CMG}}; {{AE}} {{MA}}
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==Overview==
==Overview==
It is thought that [[esophageal]] [[stricture]] is the result of lower pressure of [[esophageal sphincter]] in [[gastroesophageal reflux disease]], esophageal motor disorder, [[inflammation]] and [[fibrosis]] in [[neoplasia]]. The most characteristic finding in [[gross pathology]] is thickening of the lower esophageal wall in [[gastroesophageal reflux disease]], pale [[mucosa]] in lymphocytic [[esophagitis]] and [[hemorrhagic]] [[congestion]] in [[caustic]] ingestion.
Esophageal stricture is the result of lower pressure of [[esophageal sphincter]] in [[gastroesophageal reflux disease]], esophageal motor disorder, and [[inflammation]] and [[fibrosis]] in [[neoplasia]]. The characteristic findings on [[gross pathology]] are thickening of the lower [[esophageal]] wall in [[gastroesophageal reflux disease]], pale [[mucosa]] in [[lymphocytic]] [[esophagitis]], and [[hemorrhagic]] [[congestion]] in [[caustic]] ingestion. Characteristic [[histopathological]] findings of esophageal stricture are intraepithelial [[lymphocytes|lymphocytosis]] and [[basal cell]] [[hyperplasia]] in [[gastroesophageal reflux disease]]; [[T cell|T lymphocyte]] infiltration in [[squamous]] [[mucosa]] in [[lymphocytic]] [[esophagitis]] and [[eosinophilic]] [[necrosis]] in [[Caustic burn|caustic ingestion]].
 
[[Microscopic]] [[histopathological]] characteristic findings of esophageal [[stricture]] is inntraepithelial [[lymphocytes]] and [[basal cell]] [[hyperplasia]] in [[gastroesophageal reflux disease]], [[Infiltration (medical)|infiltration]] T [[lymphocytes]] in [[squamous]] [[mucosa]] in lymphocytic [[esophagitis]] and [[eosinophilic]] [[necrosis]] in [[caustic]] ingestion
==Pathophysiology==
==Pathophysiology==
===Pathogenesis===
===Pathogenesis===
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[[File:Esophageal stricture due to GERD.png|300px|thumb|Esophageal stricture due to GERD, via wikipedia.org<ref>From en.wikipedia.org, Public Domain, <"https://commons.wikimedia.org/w/index.php?curid=1931423"></ref>]]
[[File:Esophageal stricture due to GERD.png|300px|thumb|Esophageal stricture due to GERD, via wikipedia.org<ref>From en.wikipedia.org, Public Domain, <"https://commons.wikimedia.org/w/index.php?curid=1931423"></ref>]]
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The normal [[esophageal]] diameter is up to 30 mm. An esophageal [[stricture]] is a narrowing of the [[esophagus]] usually 13 mm or less in diameter that causes [[dysphagia]]. Peptic strictures occur usually at the squamocolumnar junction. <ref name="pmid8338082">{{cite journal |vauthors=Marks RD, Richter JE |title=Peptic strictures of the esophagus |journal=Am. J. Gastroenterol. |volume=88 |issue=8 |pages=1160–73 |year=1993 |pmid=8338082 |doi= |url=}}</ref>
The normal [[esophageal]] diameter is up to 30 mm. An esophageal stricture is a narrowing of the [[esophagus]] usually 13 mm or less in diameter that causes [[dysphagia]]. [[Peptic]] strictures occur usually at the squamocolumnar junction.<ref name="pmid8338082">{{cite journal |vauthors=Marks RD, Richter JE |title=Peptic strictures of the esophagus |journal=Am. J. Gastroenterol. |volume=88 |issue=8 |pages=1160–73 |year=1993 |pmid=8338082 |doi= |url=}}</ref>
*It is thought that esophageal [[stricture]] is the result of <ref name=":0">{{cite book | last = Holzheimer | first = R | title = Surgical treatment : evidence-based and problem-oriented | publisher = Zuckschwerdt | location = München New York | year = 2001 | isbn = 3-88603-714-2 }}</ref> <ref name="pmid24640761">{{cite journal |vauthors=Belevich VL, Ovchinnikov DV |title=[Treatment of benign esophageal stricture] |language=Russian |journal=Vestn. Khir. Im. I. I. Grek. |volume=172 |issue=5 |pages=111–4 |year=2013 |pmid=24640761 |doi= |url=}}</ref>
 
**lower pressure of esophageal sphincter in [[gastroesophageal reflux disease]],
Esophageal stricture is the result of:<ref name=":0">{{cite book | last = Holzheimer | first = R | title = Surgical treatment : evidence-based and problem-oriented | publisher = Zuckschwerdt | location = München New York | year = 2001 | isbn = 3-88603-714-2 }}</ref><ref name="pmid24640761">{{cite journal |vauthors=Belevich VL, Ovchinnikov DV |title=[Treatment of benign esophageal stricture] |language=Russian |journal=Vestn. Khir. Im. I. I. Grek. |volume=172 |issue=5 |pages=111–4 |year=2013 |pmid=24640761 |doi= |url=}}</ref>
**Esophageal motor disorder,
 
**[[Inflammation]] and [[fibrosis]] due to intrinsic disease of esophagus like [[neoplasia]],
*Lower pressure of [[esophageal sphincter]] in [[gastroesophageal reflux disease]]
**[[Esophageal]] surgical [[anastomosis]],
*[[Esophageal]] motor disorders
**[[Esophageal]] compression by other oragans
*[[Inflammation]] and [[fibrosis]] due to intrinsic diseases of [[esophagus]], such as [[neoplasia]]
*Most peptic strictures are result of chronic [[reflux esophagitis]] and the process of esophageal [[stricture]] is due to [[mucosal]] [[edema]] and [[Infiltration (medical)|infiltration]] of [[inflammatory cells]] in lamina properia and finally [[collagen]] deposits, [[fibrosis]] and [[scar]] of eshophagus.<ref name="pmid8338082" />
*Surgical esophageal [[anastomosis]]
**[[Lower esophageal sphincter]] (LES) tone is usullay less than 8 mmHg in esophageal [[stricture]] due to [[reflux esophagitis]].
*[[Esophageal]] compression by other organs
*[[Radiation therapy]] for thoracic or head and neck [[tumors]] is one of the less common cause of proximal esophageal [[stricture]] by inducing chronic [[ischemia]] and [[fibrosis]].<ref name="pmid89440642">{{cite journal |vauthors=Dhir V, Vege SS, Mohandas KM, Desai DC |title=Dilation of proximal esophageal strictures following therapy for head and neck cancer: experience with Savary Gilliard dilators |journal=J Surg Oncol |volume=63 |issue=3 |pages=187–90 |year=1996 |pmid=8944064 |doi=10.1002/(SICI)1096-9098(199611)63:3<187::AID-JSO10>3.0.CO;2-2 |url=}}</ref>
 
*Most [[peptic]] strictures are result of chronic [[reflux esophagitis]] and the process of esophageal stricture is due to [[mucosal]] [[edema]] and [[Infiltration (medical)|infiltration]] of [[inflammatory cells]] in lamina propria and finally [[collagen]] deposits, [[fibrosis]] and [[scar]] of [[esophagus]].<ref name="pmid8338082" />
**[[Lower esophageal sphincter]] (LES) tone is usually less than 8 mmHg in esophageal stricture due to [[reflux esophagitis]].
*[[Radiation therapy]] for [[thoracic]] or head and neck [[tumors]] is one of the less common cause of proximal esophageal stricture by inducing chronic [[ischemia]] and [[fibrosis]].<ref name="pmid89440642">{{cite journal |vauthors=Dhir V, Vege SS, Mohandas KM, Desai DC |title=Dilation of proximal esophageal strictures following therapy for head and neck cancer: experience with Savary Gilliard dilators |journal=J Surg Oncol |volume=63 |issue=3 |pages=187–90 |year=1996 |pmid=8944064 |doi=10.1002/(SICI)1096-9098(199611)63:3<187::AID-JSO10>3.0.CO;2-2 |url=}}</ref>
 
*[[Liquefactive necrosis]] is the mechanism of esophageal stricture in [[alkali]] ingestion and [[superficial]] [[coagulation necrosis]] is the mechanism of esophageal stricture in [[acid]] ingestion.<ref name="pmid4012549">{{cite journal |vauthors=Fisher RA, Eckhauser ML, Radivoyevitch M |title=Acid ingestion in an experimental model |journal=Surg Gynecol Obstet |volume=161 |issue=1 |pages=91–9 |year=1985 |pmid=4012549 |doi= |url=}}</ref><ref name="pmid1539568">{{cite journal |vauthors=Zargar SA, Kochhar R, Nagi B, Mehta S, Mehta SK |title=Ingestion of strong corrosive alkalis: spectrum of injury to upper gastrointestinal tract and natural history |journal=Am. J. Gastroenterol. |volume=87 |issue=3 |pages=337–41 |year=1992 |pmid=1539568 |doi= |url=}}</ref>
**A grading system for [[esophageal]] injury due to [[caustic]] ingestion:


*[[Liquefactive necrosis]] is the mechanism of esophageal [[stricture]] in [[alkali]] ingestion<ref name="pmid1539568">{{cite journal |vauthors=Zargar SA, Kochhar R, Nagi B, Mehta S, Mehta SK |title=Ingestion of strong corrosive alkalis: spectrum of injury to upper gastrointestinal tract and natural history |journal=Am. J. Gastroenterol. |volume=87 |issue=3 |pages=337–41 |year=1992 |pmid=1539568 |doi= |url=}}</ref> and superficial [[coagulation necrosis]] is the mechanism of esophageal [[stricture]] in [[acid]] ingestion.<ref name="pmid4012549">{{cite journal |vauthors=Fisher RA, Eckhauser ML, Radivoyevitch M |title=Acid ingestion in an experimental model |journal=Surg Gynecol Obstet |volume=161 |issue=1 |pages=91–9 |year=1985 |pmid=4012549 |doi= |url=}}</ref>
**A grading system for esophageal injury due to causric ingestion:
{| class="wikitable"
{| class="wikitable"
!Grade
!Grade
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==Genetics==
==Genetics==
Genes involved in the pathogenesis of esophageal stricture due to Dyskeratosis Congenita include:<ref name="pmid20301779">{{cite journal |vauthors=Adam MP, Ardinger HH, Pagon RA, Wallace SE, Bean LJH, Mefford HC, Stephens K, Amemiya A, Ledbetter N, Savage SA |title= |journal= |volume= |issue= |pages= |year= |pmid=20301779 |doi= |url=}}</ref>
[[Gene]]<nowiki/>s involved in the [[pathogenesis]] of esophageal stricture due to [[Dyskeratosis congenita|Dyskeratosis Congenita]] include:<ref name="pmid20301779">{{cite journal |vauthors=Adam MP, Ardinger HH, Pagon RA, Wallace SE, Bean LJH, Mefford HC, Stephens K, Amemiya A, Ledbetter N, Savage SA |title= |journal= |volume= |issue= |pages= |year= |pmid=20301779 |doi= |url=}}</ref>
 
*''[[ACD (gene)|ACD]]''
*''[[ACD (gene)|ACD]]''
*''CTC1''
*''CTC1''
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*''[[TINF2]]''
*''[[TINF2]]''
*''WRAP53 ''
*''WRAP53 ''
==Associated Conditions==
==Associated Conditions==
*The most important diseases associated with esophageal [[stricture]] include:
 
*The most important diseases associated with esophageal stricture include:
**[[Gastroesophageal reflux disease]]
**[[Gastroesophageal reflux disease]]
**[[Caustic]] ingestion
**[[Caustic]] ingestion


==Gross Pathology==
==Gross Pathology==
*On [[gross pathology]], circumferential thickening of the lower esophageal wall are characteristic finding of [[esophageal]] [[stricture]] due to [[gastroesophageal reflux disease]].<ref name="YamasakiOzawa2016">{{cite journal|last1=Yamasaki|first1=Yasushi|last2=Ozawa|first2=Soji|last3=Oguma|first3=Junya|last4=Kazuno|first4=Akihito|last5=Ninomiya|first5=Yamato|title=Long peptic strictures of the esophagus due to reflux esophagitis: a case report|journal=Surgical Case Reports|volume=2|issue=1|year=2016|issn=2198-7793|doi=10.1186/s40792-016-0190-1}}</ref>
 
*Pale [[mucosa]] with white [[exudate]] in lymphocytic [[esophagitis]]<ref name="MaejimaUno2016">{{cite journal|last1=Maejima|first1=Ryuhei|last2=Uno|first2=Kaname|last3=Iijima|first3=Katsunori|last4=Fujishima|first4=Fumiyoshi|last5=Noguchi|first5=Tetsuya|last6=Ara|first6=Nobuyuki|last7=Asano|first7=Naoki|last8=Koike|first8=Tomoyuki|last9=Imatani|first9=Akira|last10=Shimosegawa|first10=Tooru|title=A Japanese case of lymphocytic esophagitis|journal=Digestive Endoscopy|volume=28|issue=4|year=2016|pages=476–480|issn=09155635|doi=10.1111/den.12578}}</ref>
*On [[gross pathology]], circumferential thickening of the lower [[esophageal]] wall are characteristic finding of esophageal stricture due to [[gastroesophageal reflux disease]].<ref name="YamasakiOzawa2016">{{cite journal|last1=Yamasaki|first1=Yasushi|last2=Ozawa|first2=Soji|last3=Oguma|first3=Junya|last4=Kazuno|first4=Akihito|last5=Ninomiya|first5=Yamato|title=Long peptic strictures of the esophagus due to reflux esophagitis: a case report|journal=Surgical Case Reports|volume=2|issue=1|year=2016|issn=2198-7793|doi=10.1186/s40792-016-0190-1}}</ref>
*[[Swelling]] and [[hemorrhagic]] [[congestion]] in [[caustic]] ingestion <ref name="Contini2013">{{cite journal|last1=Contini|first1=Sandro|title=Caustic injury of the upper gastrointestinal tract: A comprehensive review|journal=World Journal of Gastroenterology|volume=19|issue=25|year=2013|pages=3918|issn=1007-9327|doi=10.3748/wjg.v19.i25.3918}}</ref>
*Pale [[mucosa]] with white [[exudate]] in [[lymphocytic]] [[esophagitis]]<ref name="MaejimaUno2016">{{cite journal|last1=Maejima|first1=Ryuhei|last2=Uno|first2=Kaname|last3=Iijima|first3=Katsunori|last4=Fujishima|first4=Fumiyoshi|last5=Noguchi|first5=Tetsuya|last6=Ara|first6=Nobuyuki|last7=Asano|first7=Naoki|last8=Koike|first8=Tomoyuki|last9=Imatani|first9=Akira|last10=Shimosegawa|first10=Tooru|title=A Japanese case of lymphocytic esophagitis|journal=Digestive Endoscopy|volume=28|issue=4|year=2016|pages=476–480|issn=09155635|doi=10.1111/den.12578}}</ref>
*[[Swelling]] and [[hemorrhagic]] [[congestion]] in [[caustic]] ingestion<ref name="Contini2013">{{cite journal|last1=Contini|first1=Sandro|title=Caustic injury of the upper gastrointestinal tract: A comprehensive review|journal=World Journal of Gastroenterology|volume=19|issue=25|year=2013|pages=3918|issn=1007-9327|doi=10.3748/wjg.v19.i25.3918}}</ref>
*Multiple yellow [[plaque]]<nowiki/>s in infectious [[esophagitis]] due to ''Candida''<ref name="pmid24719600">{{cite journal |vauthors=Wilcox CM |title=Overview of infectious esophagitis |journal=Gastroenterol Hepatol (N Y) |volume=9 |issue=8 |pages=517–9 |year=2013 |pmid=24719600 |pmc=3980995 |doi= |url=}}</ref>
*Ulceration of the [[esophagus]] in [[viral]] [[esophagitis]]
 
==Microscopic Pathology==
==Microscopic Pathology==
{| align="right"
{| align="right"
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[[File:Esophagus path.jpg|300px|thumb|Normal esophagus, via Wikimedia.org​<ref><"https://commons.wikimedia.org/wiki/File%3ATinci%C3%B3n_hematoxilina-eosina.jpg"> via Wikimedia Commons</ref>]]
[[File:Esophagus path.jpg|300px|thumb|Normal esophagus, via Wikimedia.org​<ref><"https://commons.wikimedia.org/wiki/File%3ATinci%C3%B3n_hematoxilina-eosina.jpg"> via Wikimedia Commons</ref>]]
[[File:Gastroesophageal refllux disease.jpeg|300px|thumb|Gastroesophageal refllux disease, via Wikimedia.org​<ref>"https://commons.wikimedia.org/wiki/File%3AGastroesophageal_reflux_disease_--_low_mag.jpg">via Wikimedia Commons</ref>]]
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*On microscopic histopathological analysis, characteristic findings of esophageal stricture due to [[gastroesophageal reflux disease]] are:<ref name="urlEsophageal stricture - Libre Pathology">{{cite web |url=https://librepathology.org/wiki/Esophageal_stricture |title=Esophageal stricture - Libre Pathology |format= |work= |accessdate=}}</ref>
*On [[microscopic]] [[histopathological]] analysis, characteristic findings of esophageal stricture due to [[gastroesophageal reflux disease]] are:<ref name="urlEsophageal stricture - Libre Pathology">{{cite web |url=https://librepathology.org/wiki/Esophageal_stricture |title=Esophageal stricture - Libre Pathology |format= |work= |accessdate=}}</ref>
**Intraepithelial [[lymphocyte]]s
**Intraepithelial [[lymphocyte|lymphocytosi]]s
**Basal cell [[hyperplasia]]
**[[Basal cell]] [[hyperplasia]]
**[[Ulceration]] <ref name="YamasakiOzawa2016" />
**[[Ulceration]] <ref name="YamasakiOzawa2016" />


*[[Microscopic]] [[histopathological]] characteristic findings of [[esophageal]] [[stricture]] due to [[Lymphocyte|lymphocytic]] [[esophagitis]] are:<ref name="MaejimaUno2016" />
*[[Microscopic]] [[histopathological]] characteristic findings of esophageal stricture due to [[Lymphocyte|lymphocytic]] [[esophagitis]] are:<ref name="MaejimaUno2016" />
**[[Infiltration (medical)|Infiltration]] of many [[CD3 (immunology)|CD3+]] /[[CD4+]] / [[CD8+ T cells|CD8+]] [[T lymphocytes]] in [[squamous]] [[mucosa]] in the peripapaillary region without any [[Granulocyte|granulocytes]]
**[[Infiltration (medical)|Infiltration]] of many [[CD3 (immunology)|CD3+]] /[[CD4+]] / [[CD8+ T cells|CD8+]] [[T lymphocytes]] in [[squamous]] [[mucosa]] in the peripapaillary region without any [[Granulocyte|granulocytes]]


*[[Eosinophilic]] [[necrosis]] in esophageal [[stricture]] due to [[caustic]] ingestion<ref name="Contini2013" />
*[[Eosinophilic]] [[necrosis]] in esophageal stricture due to [[caustic]] ingestion<ref name="Contini2013" />
 
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[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Medicine]]
[[Category:Medicine]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date]]
[[Category:Primary care]]

Latest revision as of 03:28, 24 October 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahda Alihashemi M.D. [2]

Overview

Esophageal stricture is the result of lower pressure of esophageal sphincter in gastroesophageal reflux disease, esophageal motor disorder, and inflammation and fibrosis in neoplasia. The characteristic findings on gross pathology are thickening of the lower esophageal wall in gastroesophageal reflux disease, pale mucosa in lymphocytic esophagitis, and hemorrhagic congestion in caustic ingestion. Characteristic histopathological findings of esophageal stricture are intraepithelial lymphocytosis and basal cell hyperplasia in gastroesophageal reflux disease; T lymphocyte infiltration in squamous mucosa in lymphocytic esophagitis and eosinophilic necrosis in caustic ingestion.

Pathophysiology

Pathogenesis

Esophageal stricture due to GERD, via wikipedia.org[1]

The normal esophageal diameter is up to 30 mm. An esophageal stricture is a narrowing of the esophagus usually 13 mm or less in diameter that causes dysphagia. Peptic strictures occur usually at the squamocolumnar junction.[2]

Esophageal stricture is the result of:[3][4]

Grade pathophysiological injury
0 Normal
1 Mucosal edema and hyperemia
2A Superficial ulcers, bleeding, exudates
2B Deep focal or circumferential ulcers
3A Focal necrosis
3B Extensive necrosis

Genetics

Genes involved in the pathogenesis of esophageal stricture due to Dyskeratosis Congenita include:[8]

Associated Conditions

Gross Pathology

Microscopic Pathology

Normal esophagus, via Wikimedia.org​[13]
Gastroesophageal refllux disease, via Wikimedia.org​[14]



























References

  1. ↑ From en.wikipedia.org, Public Domain, <"https://commons.wikimedia.org/w/index.php?curid=1931423">
  2. ↑ 2.0 2.1 Marks RD, Richter JE (1993). "Peptic strictures of the esophagus". Am. J. Gastroenterol. 88 (8): 1160–73. PMID 8338082.
  3. ↑ Holzheimer, R (2001). Surgical treatment : evidence-based and problem-oriented. München New York: Zuckschwerdt. ISBN 3-88603-714-2.
  4. ↑ Belevich VL, Ovchinnikov DV (2013). "[Treatment of benign esophageal stricture]". Vestn. Khir. Im. I. I. Grek. (in Russian). 172 (5): 111–4. PMID 24640761.
  5. ↑ Dhir V, Vege SS, Mohandas KM, Desai DC (1996). "Dilation of proximal esophageal strictures following therapy for head and neck cancer: experience with Savary Gilliard dilators". J Surg Oncol. 63 (3): 187–90. doi:10.1002/(SICI)1096-9098(199611)63:3<187::AID-JSO10>3.0.CO;2-2. PMID 8944064.
  6. ↑ Fisher RA, Eckhauser ML, Radivoyevitch M (1985). "Acid ingestion in an experimental model". Surg Gynecol Obstet. 161 (1): 91–9. PMID 4012549.
  7. ↑ Zargar SA, Kochhar R, Nagi B, Mehta S, Mehta SK (1992). "Ingestion of strong corrosive alkalis: spectrum of injury to upper gastrointestinal tract and natural history". Am. J. Gastroenterol. 87 (3): 337–41. PMID 1539568.
  8. ↑ Adam MP, Ardinger HH, Pagon RA, Wallace SE, Bean L, Mefford HC, Stephens K, Amemiya A, Ledbetter N, Savage SA. PMID 20301779. Vancouver style error: initials (help); Missing or empty |title= (help)
  9. ↑ 9.0 9.1 Yamasaki, Yasushi; Ozawa, Soji; Oguma, Junya; Kazuno, Akihito; Ninomiya, Yamato (2016). "Long peptic strictures of the esophagus due to reflux esophagitis: a case report". Surgical Case Reports. 2 (1). doi:10.1186/s40792-016-0190-1. ISSN 2198-7793.
  10. ↑ 10.0 10.1 Maejima, Ryuhei; Uno, Kaname; Iijima, Katsunori; Fujishima, Fumiyoshi; Noguchi, Tetsuya; Ara, Nobuyuki; Asano, Naoki; Koike, Tomoyuki; Imatani, Akira; Shimosegawa, Tooru (2016). "A Japanese case of lymphocytic esophagitis". Digestive Endoscopy. 28 (4): 476–480. doi:10.1111/den.12578. ISSN 0915-5635.
  11. ↑ 11.0 11.1 Contini, Sandro (2013). "Caustic injury of the upper gastrointestinal tract: A comprehensive review". World Journal of Gastroenterology. 19 (25): 3918. doi:10.3748/wjg.v19.i25.3918. ISSN 1007-9327.
  12. ↑ Wilcox CM (2013). "Overview of infectious esophagitis". Gastroenterol Hepatol (N Y). 9 (8): 517–9. PMC 3980995. PMID 24719600.
  13. ↑ <"https://commons.wikimedia.org/wiki/File%3ATinci%C3%B3n_hematoxilina-eosina.jpg"> via Wikimedia Commons
  14. ↑ "https://commons.wikimedia.org/wiki/File%3AGastroesophageal_reflux_disease_--_low_mag.jpg">via Wikimedia Commons
  15. ↑ "Esophageal stricture - Libre Pathology".

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