Benign Esophageal Stricture: Causes, Symptoms & Diagnosis

The internal tissue of the esophagus generally appears normal in endoscopy, although a “pop” may be observed as the scope is passed through the non-relaxing lower esophageal sphincter with some difficulty, and food debris may be found above the LES. Esophageal achalasia, often referred to simply as achalasia, is a failure of smooth muscle fibers to relax, which can cause the lower esophageal sphincter to remain closed. Without a modifier, “achalasia” usually refers to achalasia of the esophagus. Achalasia can happen at various points along the gastrointestinal tract; achalasia of the rectum, for instance, may occur in Hirschsprung’s disease. The immense success of laparoscopic surgery as an effective treatment of gastroesophageal reflux disease (GERD) and achalasia has established minimal invasive surgery as the gold standard in the surgical treatment of these two conditions.

people with benign esophageal stricture

Re-stricturing may continue even after the underlying process is recognized and removed due to ongoing scar formation. However, over time, the rate of re-stricturing and the accompanying need for dilation should decrease. Malignant strictures are best managed surgically. When this is not possible, radiation therapy, laser therapy and stent placement (a rigid tube that holds the channel open) are among the therapeutic approaches.

Quality of life assessment was done using the EORTC-QLC-C30 (version 3.0, 2001) [6]. The EORTC quality of life questionnaire (QLQ) is an integrated system for assessing the health-related quality of life (QoL) of patients.

Biopsies from the distal esophagus showed chronic esophagitis and Barrett’s metaplasia. Barium swallow showed dilated esophageal body with decreased peristalsis, nonrelaxing sphincter and retention of barium. Manometry and 24-hour pH monitoring was performed. The LES pressure was 34.5 mmHg with 11.9% relaxation. 24-hour pH-metry showed acid reflux, with multiple sharp dips characteristic of typical gastroesophageal reflux, with total DeMeester score of 94.6.

The innermost circular muscle layer of the esophagus is divided and extended through the LES until about 2 cm into the gastric muscle. Since this procedure is performed entirely through the patient’s mouth, there are no visible scars on the patient’s body. Johnson WE, Hagen JA, DeMeester TR, Kauer WK, Ritter MP, Peters JH, Bremner CG. Outcome of respiratory symptoms after antireflux surgery on patients with gastroesophageal reflux disease. Lord RV, Kaminski A, Oberg S, Bowrey DJ, Hagen JA, DeMeester SR, Sillin LF, Peters JH, Crookes PF, DeMeester TR. Absence of gastroesophageal reflux disease in a majority of patients taking acid suppression medications after Nissen fundoplication.

Heartburn is the main symptom of GERD. However, heartburn and regurgitation are frequently observed in patients who have achalasia. The diagnosis of achalasia might be delayed because these symptoms are misinterpreted as gastroesophageal reflux. Here, we reviewed the clinical characteristics of patients with the erroneous diagnosis of GERD who actually had untreated achalasia. In transabdomial esophago-cardio-myotomy the addition of a fundoplication has been reported to reduce the indicence of symptomatic gastroesophageal reflux to rates between 5 and 30% [15-17] but on the other hand, postoperative dysphagia was noticed in more than 50% [15].

achalasia and acid reflux
achalasia and acid reflux

Esophageal dilation

Common signs of GERD include frequent heartburn, coughing, wheezing, chest pain and regurgitation – particularly at night. Knowing which condition you have is important because acid reflux and achalasia are treated differently. If untreated (or treated incorrectly), you may continue to suffer with symptoms – and continued damage to your esophagus can become irreversible. Most of the time it’s just acid reflux, or gastroesophageal reflux disease (GERD), which affects about 1 in 5 Americans. But for about 1 in 100,000 Americans per year, it’s actually a different condition, called achalasia.

Achalasia following reflux disease: coincidence, consequence, or accommodation? An experience-based literature review

Achalasia is a motility disorder of the esophagus characterized by the defective peristaltic activity of the esophageal body and impaired relaxation of the lower esophageal sphincter due to the degeneration of the inhibitory neurons in the myenteric plexus of the esophageal wall. The histopathological and pathophysiological changes in achalasia have been well described. However, the exact etiological factors leading to the disease still remain unclear. Currently, achalasia is believed to be a multifactorial disease, involving both extrinsic and intrinsic factors.

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