Esophageal stricture, or esophageal stenosis, is one of the less dangerous complications. However, if left untreated, not only can it itself become dangerous, but it can also be a sign of other diseases. In this respect, esophageal stenosis requires immediate medical treatment in any case.
What is esophageal stricture?
The human digestive system begins in a narrow sense only from the stomach area, where by the gastric juices contained there the chewed meal is predigested and prepared for absorption in the small as well as large intestine. In order for the meal to get there, it must pass through the esophagus. The narrowing of the esophagus, which doctors refer to as esophageal stenosis, is in itself less dangerous or at least easily treatable, but it can be a sign of the presence of other underlying diseases. As the name suggests, esophageal stenosis is a spatial narrowing of the esophagus with the result that meals can no longer flow easily into the gastrointestinal tract. Difficulty in swallowing in order to use pressure to break through the narrowing is one of the typical symptoms of esophageal stenosis. In advanced cases, food that was thought to have already been swallowed flows unintentionally back into the mouth and throat of the affected person.
Causes
Several factors can be considered as possible causes of esophageal stricture. According to medical observations, esophageal stricture very often occurs in conjunction with reflux esophagitis. This is the unnatural reflux of acidic gastric juices into the esophagus. The result is then inflammation of the esophagus, which, unlike the gastric mucosa, is not designed for the pH of gastric juices. The esophagus eventually reacts to the corrosive gastric juices with inflammatory reactions. And it is precisely these inflammations that then cause esophageal stricture. But also formations from the outside, i.e. outside the esophagus, can exert pressure on the esophagus and ultimately cause a narrowing. Finally, it must be investigated whether a tumor in the esophagus is the reason for the narrowing. Congenital malformations of the esophagus, on the other hand, are among the rare causes of esophageal stricture.
Symptoms, complaints, and signs
The first signs of esophageal stricture are difficulty swallowing. Patients complain of pain and pressure sensations when swallowing, and often esophageal debris also enters the trachea, causing irritation or inflammation. As the disease progresses, the narrowing of the esophagus can lead to throat infections, heartburn and severe pain. The pain is usually sharp to throbbing. Difficulty swallowing often leads to loss of appetite and, subsequently, decreased food intake and deficiency symptoms. Eventually, serious complications such as pneumonia and lung failure can occur, usually associated with hoarseness, loss of voice, and coughing up blood. At the latest, fever, malaise and other general symptoms also set in, the nature and severity of which depend on the particular complication. A severe esophageal stenosis can be fatal. Externally, the disease is usually not detectable. Only in the later course of the disease, visible redness and swelling in the mouth and throat may occur as a result of concomitant symptoms. Progressive pneumonia relatively quickly leads to a sickly appearance with pale skin and sunken eye sockets. If the esophageal stenosis is treated early, the symptoms subside completely within a few days to weeks. Late effects or a renewed narrowing of the esophagus are not to be expected.
Diagnosis and course
The first clue to the presence of esophageal stenosis is the medical history: asking the patient about his or her complaints. In view of the fact that serious diseases with an immediate need for treatment are also possible causes, a simple anamnesis should not be enough. Further treatment measures include ultrasound to detect possible anomalies in the mediastinum and esophagus. If inflammation is suspected, the esophagus can be examined during a gastroscopy.This can be assumed whenever the patient’s blood count shows an elevated white blood cell count, indicating the presence of inflammation as the cause of esophageal stricture.
Complications
Esophageal stricture can lead to aspiration, regurgitation, pain, and difficulty swallowing – symptoms that can result in serious complications. Regurgitation can lead to inflammation and secondary diseases of the esophagus and nasopharynx. Thus, the symptom favors complications such as heartburn and throat infections. As a result of the often severe pain, there is often reduced food intake. This can result in deficiency symptoms and dehydration. Swallowing difficulties further increase the risk of such complications and can also lead to aspiration. Aspiration can lead to choking, especially in children. If the foreign body remains in the lungs, it can result in pneumonia. Recurrent aspirations may result in collapse of the lungs or even lung failure. In a severe course, esophageal stenosis ends fatally for the affected person. The treatment itself usually proceeds without major complications. However, prescribed antibiotics can cause complaints such as headaches, gastrointestinal complaints and skin irritations. In addition, such preparations rarely trigger allergic reactions or cause serious complications when they interact with other medications or diseases. In the case of surgical intervention, there is a risk of injury to the esophagus.
When should you see a doctor?
Esophageal stricture should always be treated by a doctor. If left untreated, it can lead to serious complications and discomfort, which can have a negative impact on life expectancy and also on the quality of life of the affected person. Early diagnosis of esophageal stenosis always has a positive effect on the further course of this disease. A doctor should be consulted if the patient suffers from severe swallowing difficulties that do not disappear on their own. This may include severe heartburn, and the throat and also the oral cavity may be affected by infections. Severe loss of appetite may also be indicative of esophageal stricture and must be investigated by a physician if it persists for an extended period of time without a specific reason. Furthermore, many patients also suffer from hoarseness or even hemoptysis. Esophageal stricture can be diagnosed and treated by an otolaryngologist or by an internist.
Treatment and therapy
The cause of esophageal stricture is rarely found in a congenital malformation of the esophagus. For this reason, the medical gold standard includes identifying and treating the underlying disease of esophageal stenosis. In case of esophageal inflammation, appropriate antibiotics are prescribed after determining the pathogen. By killing the pathogens, the inflammation, and thus the esophageal stricture, subsides on its own. If, on the other hand, the cause is a tumor, surgical removal of the tumor is the obvious choice. If, contrary to expectations, the esophageal stricture does not subside as a result of treatment of the underlying disease and if no other causes can be considered, the esophagus must be “inflated”. To do this, an elastic instrument is inserted into the esophagus and inflated. The aim is to mechanically stretch the esophagus so that food can flow through it again without problems. Depending on the severity of the esophageal stenosis and the need, this treatment measure can be repeated at regular intervals.
Prevention
Because of the different causes that esophageal stricture can have, there can be no blanket recommendation on how to prevent it. While underlying conditions such as the formation of a tumor can neither be predicted nor effectively prevented anyway, prophylaxis of esophageal stenosis is ruled out entirely in this respect. The same applies to non-tumor-like formations in the midfield with an idiopathic background. Inflammations of the esophagus caused solely by pathogens can be prevented by adherence to the general rules of a conscious diet in conjunction with sufficient physical exercise. They are considered guarantors for strengthening the immune system and preventing the outbreak of inflammation and thus esophageal stenosis even in the event of pathogen infection.
Aftercare
In most cases, those affected by esophageal stenosis have very few measures or options for direct aftercare. For this reason, this condition must be diagnosed and treated at an early stage to prevent complications or other medical conditions from developing further down the line. As a rule, the disease cannot heal on its own, so the affected person should consult a doctor at the first symptoms and signs of this disease. In most cases, esophageal stricture can be alleviated by taking various medications. However, the affected person should always take the medication regularly and in the correct dosage to limit the symptoms. Likewise, when taking antibiotics, it should be noted that they should not be taken together with alcohol. Furthermore, regular checks of the esophagus are very useful to detect further damage at an early stage and also to treat it. The esophageal stenosis does not always reduce the life expectancy of the affected person. However, the further course is strongly dependent on the expression and also on the cause of the disease, so that a general prediction can usually not be made.
What you can do yourself
If the esophagus is narrowed, any stress in the area of the neck should be refrained from. This could cause further discomfort, which is of little use in the healing process. The intake of food should be optimized and adapted to the possibilities of the organism. As a consequence, meals should be strongly crushed in the mouth. The intake of soups or mushy foods is recommended, especially in acute phases. The grinding process of the teeth should be intensified to prevent larger pieces of food from entering the throat. In addition, irritation of the throat should be completely avoided. The consumption of nicotine is to be actively as well as passively refrained from. Places where gases or dyes are in the air should not be visited. An oxygen-rich environment and good ventilation of rooms is important to optimize respiratory flow. When in cold environments, the throat area should be adequately protected by wearing clothing. Caution should be exercised when dealing with people who have a viral illness. Transmission of the disease can lead to complications esophagus, from which the affected person should protect himself. Likewise, heavy use of the voice should be refrained from. The processes could cause irritation in the throat area.