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.
a) History of ingestion.
b) Symptoms: Shock, burning sensation.
c) Endoscopy to determine the damage.
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.
a) Dilatation of stricture if present.
b) Oesophageal replacement surgery with colon or stomach may be necessary.
a) Usually at gastro-oesophageal junction.
b) In severe cases long stricture may result.
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.
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.