Esophageal stricture overview: Difference between revisions
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{{Esophageal stricture}} | {{Esophageal stricture}} | ||
{{CMG}}; {{AE}}{{MA}} [mailto:malihash@bidmc.harvard.edu] | {{CMG}}; {{AE}}{{MA}} [mailto:malihash@bidmc.harvard.edu] [mailto:malihash@bidmc.harvard.edu] | ||
==Overview== | ==Overview== | ||
==Historical Perspective== | ==Historical Perspective== | ||
First intervention for esophaegal stricture was done in the 17 century by whalebone. The first bougienage was performed in 1801. In 1868, esophagoscope was developed for the first time. In 1877, first surgical [[resection]] for esophaegal [[carcinoma]] was performed by Vincenz Czerny. First stent was introduced in 1990. | |||
==Classification== | ==Classification== | ||
There is no established system for the classification of [[esophageal]] [[stricture]], but it may be classified into [[benign]] and [[malignant]] according to causes. | |||
==Pathophysiology== | ==Pathophysiology== | ||
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. | |||
[[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 | |||
==Causes== | ==Causes== | ||
Common causes of [[esophageal]] [[stricture]] include [[gastroesophageal reflux disease]] and [[caustic]] ingestions. | |||
==Differentiating | ==Differentiating esophageal stricture from Other Diseases== | ||
Esophageal stricture must be differentiated from plummer-vinson syndrome, [[achalasia]] , [[diffuse esophageal spasm]], [[systemic sclerosis]], [[zenker's diverticulum]], [[Esophageal cancer|esophageal carcinoma]], [[stroke]], motor disorders, [[GERD]][[Esophageal web|, esophageal web]]. | |||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
Most of [[esophageal]] [[strictures]] are related to [[gastroesophageal reflux disease]]. Overall incidence of [[esophageal stricture]] is approximately 11 per 100,000 individuals and the [[prevalence]] of [[esophageal]][[stricture]] is approximately 70-120 per 100,000 individuals in united states. The [[incidence]] of [[esophageal]] [[stricture]] increases with age. There is no racial predilection to [[esophageal]] [[stricture]]. The risk of [[esophageal]] [[stricture]] is higher in men under 60 yr but there is similar [[incidence]] in men and women after age 60. | |||
==Risk Factors== | ==Risk Factors== | ||
The most potent [[risk factor]] in the development of [[esophageal]] [[stricture]] is frequent [[acid reflux]]. Other [[risk factor]]<nowiki/>s include [[Hiatus hernia|hiatal hernia]], [[obesity]], [[smoking]], [[esophageal dysmotility]], increased [[gastric]] acidity, and heavy [[alcohol]] use. | |||
==Screening== | ==Screening== | ||
There is insufficient evidence to recommend routine [[screening]] for [[esophageal]] [[stricture]]. | |||
==Natural History, Complications, and Prognosis== | ==Natural History, Complications, and Prognosis== | ||
If left untreated, patients with [[esophageal]] [[stricture]] may progress to develop [[pulmonary aspiration]], [[weight loss]], and [[dehydration]]. Common [[complication]]<nowiki/>s of [[esophageal]] [[stricture]] include [[perforation]], [[bleeding]], [[pneumonia]], [[bacteremia]]. [[Prognosis]] is generally good but recurrence of symptoms after [[dilation]] are prevalent and usually recurrent [[dilation]] is necessary. | |||
==Diagnosis== | ==Diagnosis== | ||
===Diagnostic | ===Diagnostic study of choice=== | ||
[[Esophageal]] [[stricture]] is diagnosed based on history of [[dysphagia]] and diagnostic studies such as barium [[Esophagogram|esophagography]], [[esophagogastroduodenoscopy]], [[endoscopic ultrasound]], [[manometry]]. | |||
===History and Symptoms=== | ===History and Symptoms=== | ||
The hallmark of [[esophageal]] [[stricture]] is [[dysphagia]] . A positive history of [[heartburn]] is suggestive of [[esophageal]] [[stricture]]. The most common symptoms of [[esophageal]] [[stricture]] include [[dysphagia]], [[odynophagia]], and [[heartburn]]. Less common symptoms of [[esophageal]] [[stricture]] include [[Chronic (medical)|chronic]] [[cough]] and [[wheezing]]. | |||
===Physical Examination=== | ===Physical Examination=== | ||
Patients with [[esophageal cancer]] can usually appear normal. [[Cachexia]] and [[pallor]] are notable in patients with [[esophageal]] [[stricture]] due to [[malignant]] causes. | |||
===Laboratory Findings=== | ===Laboratory Findings=== | ||
Laboratory findings are usually normal among patients with [[esophageal]] [[stricture]] although [[anemia]] may be seen with [[malignant]] causes of [[esophageal]] [[stricture]]. Other possible laboratory test are high serum [[gastrin]] level in zollinger ellison syndrome and peripheral [[eosinophilia]] in [[eosinophilic esophagitis]] as causes of esophageal stricture. | |||
===Electrocardiogram=== | ===Electrocardiogram=== | ||
There are no ECG findings associated with esophageal stricture. | |||
===X-ray=== | ===X-ray=== | ||
A [[Chest X-ray|chest x-ray]] may be helpful in the diagnosis of [[tumors]] as a cause of [[esophageal]] [[stricture]]. | |||
===CT scan=== | ===CT scan=== | ||
[[Chest]] [[CT scan]] may be helpful in the diagnosis of [[malignant]] causes of [[esophageal]] [[stricture]]. | |||
===MRI=== | ===MRI=== | ||
In general [[MRI]] has not been routinely recommended for [[esophageal]] [[stricture]]. | |||
'''Echocardiography or Ultrasound''' | |||
===Other Imaging Findings=== | ===Other Imaging Findings=== | ||
Revision as of 15:45, 22 November 2017
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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] [3] [4]
Overview
Historical Perspective
First intervention for esophaegal stricture was done in the 17 century by whalebone. The first bougienage was performed in 1801. In 1868, esophagoscope was developed for the first time. In 1877, first surgical resection for esophaegal carcinoma was performed by Vincenz Czerny. First stent was introduced in 1990.
Classification
There is no established system for the classification of esophageal stricture, but it may be classified into benign and malignant according to causes.
Pathophysiology
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.
Microscopic histopathological characteristic findings of esophageal stricture is inntraepithelial lymphocytes and basal cell hyperplasia in gastroesophageal reflux disease, infiltration T lymphocytes in squamous mucosa in lymphocytic esophagitis and eosinophilic necrosis in caustic ingestion
Causes
Common causes of esophageal stricture include gastroesophageal reflux disease and caustic ingestions.
Differentiating esophageal stricture from Other Diseases
Esophageal stricture must be differentiated from plummer-vinson syndrome, achalasia , diffuse esophageal spasm, systemic sclerosis, zenker's diverticulum, esophageal carcinoma, stroke, motor disorders, GERD, esophageal web.
Epidemiology and Demographics
Most of esophageal strictures are related to gastroesophageal reflux disease. Overall incidence of esophageal stricture is approximately 11 per 100,000 individuals and the prevalence of esophagealstricture is approximately 70-120 per 100,000 individuals in united states. The incidence of esophageal stricture increases with age. There is no racial predilection to esophageal stricture. The risk of esophageal stricture is higher in men under 60 yr but there is similar incidence in men and women after age 60.
Risk Factors
The most potent risk factor in the development of esophageal stricture is frequent acid reflux. Other risk factors include hiatal hernia, obesity, smoking, esophageal dysmotility, increased gastric acidity, and heavy alcohol use.
Screening
There is insufficient evidence to recommend routine screening for esophageal stricture.
Natural History, Complications, and Prognosis
If left untreated, patients with esophageal stricture may progress to develop pulmonary aspiration, weight loss, and dehydration. Common complications of esophageal stricture include perforation, bleeding, pneumonia, bacteremia. Prognosis is generally good but recurrence of symptoms after dilation are prevalent and usually recurrent dilation is necessary.
Diagnosis
Diagnostic study of choice
Esophageal stricture is diagnosed based on history of dysphagia and diagnostic studies such as barium esophagography, esophagogastroduodenoscopy, endoscopic ultrasound, manometry.
History and Symptoms
The hallmark of esophageal stricture is dysphagia . A positive history of heartburn is suggestive of esophageal stricture. The most common symptoms of esophageal stricture include dysphagia, odynophagia, and heartburn. Less common symptoms of esophageal stricture include chronic cough and wheezing.
Physical Examination
Patients with esophageal cancer can usually appear normal. Cachexia and pallor are notable in patients with esophageal stricture due to malignant causes.
Laboratory Findings
Laboratory findings are usually normal among patients with esophageal stricture although anemia may be seen with malignant causes of esophageal stricture. Other possible laboratory test are high serum gastrin level in zollinger ellison syndrome and peripheral eosinophilia in eosinophilic esophagitis as causes of esophageal stricture.
Electrocardiogram
There are no ECG findings associated with esophageal stricture.
X-ray
A chest x-ray may be helpful in the diagnosis of tumors as a cause of esophageal stricture.
CT scan
Chest CT scan may be helpful in the diagnosis of malignant causes of esophageal stricture.
MRI
In general MRI has not been routinely recommended for esophageal stricture.
Echocardiography or Ultrasound
