Benign esophageal strictures

Abstract

SUMMARYE sophageal strictures refer to the abnormal narrowing of the esophagus. This typically manifests as dysphagia, which is described by patients as difficulty swallowing. It is a serious consequence of various disease processes and underlying etiologies. Benign strictures imply that they are not caused by esophageal cancer and are attributed to factors such as inflammation, esophagitis, and scar tissue that lead to the narrowing of the esophagus. Diagnosis and treatment should be prompt. Appropriate treatment depends on determining the correct etiology of the stricture. The majority of esophageal strictures are caused by benign peptic strictures resulting from long-term gastroesophageal reflux disease and account for 70-80% of adult cases. In the pediatric and adolescent population, the leading cause of esophageal stricture formation is the ingestion of corrosive substances. These strictures particularly affect the quality of life of patients due to dysphagia and can lead to serious complications such as malnutrition, weight loss, and aspiration. Bougie or balloon endoscopic dilation is the initial standard treatment for these lesions. However, 30-40% of these strictures can recur during long-term follow-up and may require repeated dilation or even surgery. Furthermore, 10% of patients may be refractory, not responding to endoscopic dilation and experiencing no significant improvement. The most common symptom of esophageal strictures is dysphagia, which is difficulty swallowing solid foods. The functional staging of dysphagia is as follows: Stage 1 - Normal, Stage 2 - Requires water to swallow solid foods, Stage 3 - Can swallow semi-solid foods, Stage 4 - Can swallow saliva, Stage 5 - Unable to swallow saliva. The types of dysphagia can serve as a guide for swallowing disorders. Dysphagia only for solid foods indicates mechanical obstruction due to esophageal stricture. Other types of dysphagia include acute, oropharyngeal, esophageal, difficulty swallowing liquids, progressive, and intermittent. Symptoms accompanying dysphagia include retrosternal burning or chest pain, weight loss, hematemesis, anemia, regurgitation, and aspiration. When the esophagus is narrowed, dense and solid foods can become stuck in the esophagus. This can cause choking or difficulty breathing. Swallowing problems can prevent the patient from consuming an adequate amount of food and fluids, leading to the risk of dehydration and malnutrition. Additionally, there is a risk of vomiting and aspiration of food or liquids into the lungs, which can lead to aspiration pneumonia.