ESOPHAGEAL
STRICTURES
An esophageal stricture is characterized by an area of the esophagus in which there is narrowing of the lumen, typically in response to an inflammatory/fibrotic and sometimes a neoplastic process. Strictures may be of variable length, diameter, and location, depending on the underlying cause. Numerous diseases and processes may lead to esophageal stricture formation. The variables that most affect stricture formation are the chronicity and severity of the inflammatory process and the extent of the esophagus involved. For example, acute inflammatory processes such as pillinduced esophagitis tend to lead to selfresolving strictures. In contrast, chronic conditions such as prior radiation exposure lead to longstanding fibrotic strictures in response to chronic unremitting inflammation. Similarly, a disease such as gastroesophageal reflux will most severely affect the distal esophagus given the greater likelihood of acid exposure when compared with the proximal esophagus. In contrast, eosinophilic esophagitis affects the entire esophagus and therefore may cause the entire esophagus to stricture. Other conditions that may involve the entire esophagus include lichen planus, caustic ingestion, and prolonged nasogastric tube use.
Esophageal neoplasia may cause a
stricture. For example, primary esophageal cancers such as adenocarcinoma or
squamous cell carcinoma may lead to stricture formation through infiltration of
the esophageal wall with a combination of inflammatory and neoplastic
processes. Indeed, these tumors may present with a linitis plastica pattern
similar to that seen in the stomach. Primary esophageal lymphoma may also arise in
the esophageal wall and resemble a long benign stricture. As a result,
exclusion of malignancy in patients with esophageal strictures may be
challenging when strictures involve the esophageal submucosa and are not
readily visible or detected on endoscopic mucosal biopsy. Malignancy may also
cause esophageal narrowing without classic stricture formation. For example,
submucosal esophageal lesions such as leiomyomas or granular cell tumors may
narrow the esophageal lumen but not cause a stricture.
