Esophageal stricture medical therapy: Difference between revisions

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Main stay of treatment of esophageal stricture is dilatation.
Supportive medical therapy for esophageal stricture secondary to Gastroesophageal reflux disease includes proton pump inhibitors.
Proton pump inhibitors also help in prevention of recurrence after surgical esophageal dilatation.
Proton pump inhibitors have been found more effective in acid suppression in these patients as compared to H2 blockers.
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{{Esophageal stricture}}
{{Esophageal stricture}}
{{CMG}}; {{AE}}  
{{CMG}}; {{AE}} {{MA}}


==Overview==
==Overview==


The mainstay of treatment for esophageal stricture is dilation
The mainstay of treatment for esophageal stricture is [[dilation]]. [[Pharmacologic]] medical therapy for esophageal stricture secondary to [[gastroesophageal reflux disease]] includes [[Proton pump inhibitor|proton pump inhibitors]] or [[Histamine-2 receptor blocker|H2 antagonist<nowiki/>s]]. Patients are advised to consider lifestyle modification for [[gastroesophageal reflux disease]].
 
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
 
OR
 
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
 
OR
 
The majority of cases of [disease name] are self-limited and require only supportive care.
 
OR
 
[Disease name] is a medical emergency and requires prompt treatment.
 
OR
 
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR
 
[Therapy] is recommended among all patients who develop [disease name].
 
OR
 
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
 
OR
 
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
 
OR
 
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
 
OR
 
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].


==Medical Therapy==
==Medical Therapy==
* The mainstay of treatment for esophageal stricture is dilation.<ref name="pmid7926495">{{cite journal |vauthors=Smith PM, Kerr GD, Cockel R, Ross BA, Bate CM, Brown P, Dronfield MW, Green JR, Hislop WS, Theodossi A |title=A comparison of omeprazole and ranitidine in the prevention of recurrence of benign esophageal stricture. Restore Investigator Group |journal=Gastroenterology |volume=107 |issue=5 |pages=1312–8 |year=1994 |pmid=7926495 |doi= |url=}}</ref>
* The mainstay of treatment for esophageal stricture is [[dilation]].<ref name="pmid7926495">{{cite journal |vauthors=Smith PM, Kerr GD, Cockel R, Ross BA, Bate CM, Brown P, Dronfield MW, Green JR, Hislop WS, Theodossi A |title=A comparison of omeprazole and ranitidine in the prevention of recurrence of benign esophageal stricture. Restore Investigator Group |journal=Gastroenterology |volume=107 |issue=5 |pages=1312–8 |year=1994 |pmid=7926495 |doi= |url=}}</ref> Self [[dilation]] can be considered at home with bougie dilators.<ref name="pmid23925823">{{cite journal |vauthors=Dzeletovic I, Fleischer DE, Crowell MD, Pannala R, Harris LA, Ramirez FC, Burdick GE, Rentz LA, Spratley RV, Helling SD, Alexander JA |title=Self-dilation as a treatment for resistant, benign esophageal strictures |journal=Dig. Dis. Sci. |volume=58 |issue=11 |pages=3218–23 |year=2013 |pmid=23925823 |doi=10.1007/s10620-013-2822-7 |url=}}</ref>
 
* Proton pump inhibitors or H2 antagonists are recommended among all patients  who develop esophageal stricture due to gastroesophageal reflux disease. Studies show proton pump inhibitors are more effective than acid blocking agent<ref name="pmid7926495" /><ref name="pmid7848395">{{cite journal |vauthors=Marks RD, Richter JE, Rizzo J, Koehler RE, Spenney JG, Mills TP, Champion G |title=Omeprazole versus H2-receptor antagonists in treating patients with peptic stricture and esophagitis |journal=Gastroenterology |volume=106 |issue=4 |pages=907–15 |year=1994 |pmid=7848395 |doi= |url=}}</ref>
 
* '''Life Style Modification''' 
** For esophageal stricture due to gastroesophageal reflux disease, patients are advised to avoid: <ref>{{Cite journal|last=Richter|first=Joel|date=2009|title=Advances in GERD Current Developments in the Management of Acid-Related GI Disorders|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886414/|journal=Gastroenterol Hepatol (N Y)|volume=5|pages=613-615|via=}}</ref><ref name="pmid16682569">{{cite journal |author=Kaltenbach T, Crockett S, Gerson LB |title=Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach |journal=Arch. Intern. Med. |volume=166 |issue=9 |pages=965–71 |year=2006 |pmid=16682569 |doi=10.1001/archinte.166.9.965}}</ref>  
*** Spicy foods,
*** Tobacco,
*** Alchohol
*** Peppermint
*** Chocolate 
*** Food before bedtime  


* Pneumatic or bougie dilation is the standard treatment<ref name="pmid26828759">{{cite journal |vauthors=Repici A, Small AJ, Mendelson A, Jovani M, Correale L, Hassan C, Ridola L, Anderloni A, Ferrara EC, Kochman ML |title=Natural history and management of refractory benign esophageal strictures |journal=Gastrointest. Endosc. |volume=84 |issue=2 |pages=222–8 |year=2016 |pmid=26828759 |doi=10.1016/j.gie.2016.01.053 |url=}}</ref>
* [[Pharmacologic]] medical therapy is recommended among all patients who develop [[esophageal]] stricture due to [[gastroesophageal reflux disease]]. Studies show [[Proton pump inhibitor|proton pump inhibitors]] are more effective than acid blocking agent.<ref name="pmid7926495" /><ref name="pmid7848395">{{cite journal |vauthors=Marks RD, Richter JE, Rizzo J, Koehler RE, Spenney JG, Mills TP, Champion G |title=Omeprazole versus H2-receptor antagonists in treating patients with peptic stricture and esophagitis |journal=Gastroenterology |volume=106 |issue=4 |pages=907–15 |year=1994 |pmid=7848395 |doi= |url=}}</ref>
* Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].


*[[Brachytherapy]] is recommended among patients with malignant esophageal stricture with a life expectancy more than three months.<ref name="pmid18250638">{{cite journal |vauthors=Siersema PD |title=Treatment options for esophageal strictures |journal=Nat Clin Pract Gastroenterol Hepatol |volume=5 |issue=3 |pages=142–52 |year=2008 |pmid=18250638 |doi=10.1038/ncpgasthep1053 |url=}}</ref>
=== Lifestyle modification ===
*Self dilation at home  with bougie dilators <ref name="pmid23925823">{{cite journal |vauthors=Dzeletovic I, Fleischer DE, Crowell MD, Pannala R, Harris LA, Ramirez FC, Burdick GE, Rentz LA, Spratley RV, Helling SD, Alexander JA |title=Self-dilation as a treatment for resistant, benign esophageal strictures |journal=Dig. Dis. Sci. |volume=58 |issue=11 |pages=3218–23 |year=2013 |pmid=23925823 |doi=10.1007/s10620-013-2822-7 |url=}}</ref>
:For esophageal stricture due to [[gastroesophageal reflux disease]], patients are advised to avoid:<ref>{{Cite journal|last=Richter|first=Joel|date=2009|title=Advances in GERD Current Developments in the Management of Acid-Related GI Disorders|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886414/|journal=Gastroenterol Hepatol (N Y)|volume=5|pages=613-615|via=}}</ref><ref name="pmid16682569">{{cite journal |author=Kaltenbach T, Crockett S, Gerson LB |title=Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach |journal=Arch. Intern. Med. |volume=166 |issue=9 |pages=965–71 |year=2006 |pmid=16682569 |doi=10.1001/archinte.166.9.965}}</ref>  
 
:* [[Spicy food|Spicy food<nowiki/>s]]  
*Antibiotics for infectious causes of esophageal stricture
:* [[Tobacco]]  
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
:* [[Alcohol]]
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
:* [[Peppermint]]
* Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
:* [[Chocolate]]  
* Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
:* [[Food]] before bedtime 
* Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
* Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].


===Esophageal stricture===
===Esophageal stricture===
* '''Adult<ref name="pmid79264952">{{cite journal |vauthors=Smith PM, Kerr GD, Cockel R, Ross BA, Bate CM, Brown P, Dronfield MW, Green JR, Hislop WS, Theodossi A |title=A comparison of omeprazole and ranitidine in the prevention of recurrence of benign esophageal stricture. Restore Investigator Group |journal=Gastroenterology |volume=107 |issue=5 |pages=1312–8 |year=1994 |pmid=7926495 |doi= |url=}}</ref>'''
* '''Adult<ref name="pmid79264952">{{cite journal |vauthors=Smith PM, Kerr GD, Cockel R, Ross BA, Bate CM, Brown P, Dronfield MW, Green JR, Hislop WS, Theodossi A |title=A comparison of omeprazole and ranitidine in the prevention of recurrence of benign esophageal stricture. Restore Investigator Group |journal=Gastroenterology |volume=107 |issue=5 |pages=1312–8 |year=1994 |pmid=7926495 |doi= |url=}}</ref>'''
** Preferred regimen : Omeprazole (Prilosec) :20 mg PO daily following esophageal dilatation.
** Preferred regimen : [[Omeprazole]] (Prilosec) :20 mg [[Per os|P.O.]] daily following [[esophageal]] [[Dilation|dilatation]]
*** Omeprazole (Prilosec): 40 mg twice daily for patients who do not respond to the standard dose
*** [[Omeprazole]] (Prilosec): 40 mg twice daily for nonresponders to the [[standard]] [[dose]]
** Alternative regimen : Ranitidine 150 mg twice daily
** Alternative regimen : [[Ranitidine]] 150 mg twice daily


* '''Pediatric<ref name="HaganderMuszynska2012">{{cite journal|last1=Hagander|first1=Lars|last2=Muszynska|first2=Carolina|last3=Arnbjornsson|first3=Einar|last4=Sandgren|first4=Katarina|title=Prophylactic Treatment with Proton Pump Inhibitors in Children Operated on for Oesophageal Atresia|journal=European Journal of Pediatric Surgery|volume=22|issue=02|year=2012|pages=139–142|issn=0939-7248|doi=10.1055/s-0032-1308698}}</ref>'''
* '''Pediatric<ref name="HaganderMuszynska2012">{{cite journal|last1=Hagander|first1=Lars|last2=Muszynska|first2=Carolina|last3=Arnbjornsson|first3=Einar|last4=Sandgren|first4=Katarina|title=Prophylactic Treatment with Proton Pump Inhibitors in Children Operated on for Oesophageal Atresia|journal=European Journal of Pediatric Surgery|volume=22|issue=02|year=2012|pages=139–142|issn=0939-7248|doi=10.1055/s-0032-1308698}}</ref>'''
** Omeprazole 2 mg/kg PO per day
** [[Omeprazole]] 2 mg/kg [[Per os|P.O.]] per day
 
*
 
=== Neonates (Off-label) ===
Refractory duodenal ulcer or reflux esophagitis: 0.5-1.5 mg/kg PO qDay for up to 8 weeks


==References==
==References==
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Latest revision as of 21:41, 29 July 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

The mainstay of treatment for esophageal stricture is dilation. Pharmacologic medical therapy for esophageal stricture secondary to gastroesophageal reflux disease includes proton pump inhibitors or H2 antagonists. Patients are advised to consider lifestyle modification for gastroesophageal reflux disease.

Medical Therapy

  • The mainstay of treatment for esophageal stricture is dilation.[1] Self dilation can be considered at home with bougie dilators.[2]

Lifestyle modification

For esophageal stricture due to gastroesophageal reflux disease, patients are advised to avoid:[4][5]

Esophageal stricture

References

  1. ↑ 1.0 1.1 Smith PM, Kerr GD, Cockel R, Ross BA, Bate CM, Brown P, Dronfield MW, Green JR, Hislop WS, Theodossi A (1994). "A comparison of omeprazole and ranitidine in the prevention of recurrence of benign esophageal stricture. Restore Investigator Group". Gastroenterology. 107 (5): 1312–8. PMID 7926495.
  2. ↑ Dzeletovic I, Fleischer DE, Crowell MD, Pannala R, Harris LA, Ramirez FC, Burdick GE, Rentz LA, Spratley RV, Helling SD, Alexander JA (2013). "Self-dilation as a treatment for resistant, benign esophageal strictures". Dig. Dis. Sci. 58 (11): 3218–23. doi:10.1007/s10620-013-2822-7. PMID 23925823.
  3. ↑ Marks RD, Richter JE, Rizzo J, Koehler RE, Spenney JG, Mills TP, Champion G (1994). "Omeprazole versus H2-receptor antagonists in treating patients with peptic stricture and esophagitis". Gastroenterology. 106 (4): 907–15. PMID 7848395.
  4. ↑ Richter, Joel (2009). "Advances in GERD Current Developments in the Management of Acid-Related GI Disorders". Gastroenterol Hepatol (N Y). 5: 613–615.
  5. ↑ Kaltenbach T, Crockett S, Gerson LB (2006). "Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach". Arch. Intern. Med. 166 (9): 965–71. doi:10.1001/archinte.166.9.965. PMID 16682569.
  6. ↑ Smith PM, Kerr GD, Cockel R, Ross BA, Bate CM, Brown P, Dronfield MW, Green JR, Hislop WS, Theodossi A (1994). "A comparison of omeprazole and ranitidine in the prevention of recurrence of benign esophageal stricture. Restore Investigator Group". Gastroenterology. 107 (5): 1312–8. PMID 7926495.
  7. ↑ Hagander, Lars; Muszynska, Carolina; Arnbjornsson, Einar; Sandgren, Katarina (2012). "Prophylactic Treatment with Proton Pump Inhibitors in Children Operated on for Oesophageal Atresia". European Journal of Pediatric Surgery. 22 (02): 139–142. doi:10.1055/s-0032-1308698. ISSN 0939-7248.

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