OESOPHAGEAL STRICTURES
Oesophageal strictures can be divided into:
I) Caustic strictures.
II) Strictures secondary to esophagitis and reflux.
I) Caustic strictures
Aetiology: Ingestion of caustic agents such as dye, drain openers, acids.
Diagnosis:
a) History of ingestion.
b) Symptoms: Shock, burning sensation.
c) Endoscopy to determine the damage.
Treatment:
Medical:
a) Neutralizing agent.
b) Corticosteroids and broad-spectrum antibiotics for 3-6 weeks.
c) Barium swallow of the oesophagus performed after 10-14 days to determine development of stricture.
Surgical:
a) Dilatation of stricture if present.
b) Oesophageal replacement surgery with colon or stomach may be necessary.
Pathophysiology:
a) Usually at gastro-oesophageal junction.
b) In severe cases long stricture may result.
Diagnosis:
a) History of reflux symptoms and dysphagia is suggestive of strictures.
b) Barium swallow of the oesophagus confirms the diagnosis.
c) Fibre-optic upper GI endoscopy done to locate the site of the stricture and take a biopsy if required.
d) Rigid oesophagoscopy is important to determine the extent of disease,rule out malignancy and take a biopsy if required.
Treatment:
a) Dilatation of the oesophagus by fibre optic oesophagoscopy is attempted first and anti-reflux operation is performed.
b) Reconstructive surgery using stomach or colon.
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