Esophageal Stricture

An oesophageal stricture is a fixed narrowing produced by scar tissue in the oesophageal wall. Food has less room to pass, so the first clue is usually dysphagia to solid food. As the lumen becomes tighter, liquids also stop passing easily. Chronic gastro-oesophageal reflux is a common cause. Repeated acid exposure inflames and injures the mucosa; healing then lays down collagen and contracts the tissue. The original inflammation may improve, but the contracted scar remains. Radiation injury, caustic ingestion, healing at a surgical anastomosis, and eosinophilic oesophagitis can produce the same end result through different forms of chronic injury and remodelling. The pattern is mechanical, but it is not automatically benign. Progressive dysphagia can also reflect an oesophageal malignancy. Weight loss may result from avoiding food, but it may also signal cancer; anemia, overt gastrointestinal bleeding, odynophagia, or persistent vomiting make the need for prompt investigation even more pressing. A useful distinction is where and how the swallowing problem begins. Difficulty initiating a swallow, coughing immediately, or choking suggests an oropharyngeal swallowing disorder. A sensation of food stopping behind the...