Dig Dis. 2009;27(1):31-7. Epub 2009 May 8.

Peptic esophageal stricture: medical treatment.

Pregun I, Hritz I, Tulassay Z, Herszényi L.

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2nd Department of Medicine, Semmelweis University and Clinical Gastroenterology Research Unit, Hungarian Academy of Sciences, Budapest, Hungary. pregunistvan@yahoo.com

Abstract

Peptic esophageal stricture as a consequence of gastroesophageal reflux disease is the most frequent among benign esophageal strictures. The incidence is low and has been decreasing since the 1990s with a parallel increase in proton pump inhibitor use. Dysphagia is a common symptom: accurate diagnostic procedures (barium esophagogram, upper endoscopy with biopsies) have to be performed to exclude malignant causes first. Medical (acid-suppressive) therapy, endoscopic dilation and surgical intervention are the main therapeutic options. Based on the results of randomized and observational studies evaluating the effect of acid-suppressive therapy on peptic stricture outcome, healing the coexistent esophagitis seems to be essential. Effective acid-suppressive therapy with proton pump inhibitors may reduce the need for repeated dilations and provide symptom relief and better clinical outcome. In refractory strictures, local steroid injection is likely beneficial.

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