What are the symptoms of esophageal stricture?

Symptoms of Esophageal Stricture

The characteristic symptom of esophageal stricture is dysphagia to solids more than liquids, which distinguishes it from esophageal motility disorders where dysphagia occurs with both solids and liquids. 1

Primary Symptoms

• Progressive dysphagia - Difficulty swallowing that typically worsens over time, initially affecting solid foods and progressing to softer foods and liquids in severe cases 1
• Food impaction - Sensation of food getting stuck in the esophagus, which may require emergency intervention 1
• Regurgitation - Undigested food returns to the mouth, particularly when lying down or bending over 1
• Chest pain - May occur during or after swallowing, though transient chest pain can also occur following dilatation procedures 1

Secondary Symptoms

• Weight loss - Due to reduced oral intake resulting from dysphagia 1
• Aspiration pneumonia - Can develop when food or liquid enters the lungs due to regurgitation 1
• Malnutrition - Result of prolonged difficulty with food intake 1
• Heartburn - Particularly common in peptic strictures caused by gastroesophageal reflux disease (GERD) 1

Symptom Variation by Stricture Type

Peptic Strictures

• Typically present with long-standing history of reflux symptoms before developing dysphagia 2
• Often accompanied by heartburn and regurgitation 1, 2
• Symptoms may improve with acid-suppressing medications 3

Post-surgical/Anastomotic Strictures

• Dysphagia typically develops within months after surgery 1
• Detected in approximately 7-8% of adults with history of esophageal atresia repair 1

Caustic/Corrosive Strictures

• Dysphagia and regurgitation are the main symptoms 1
• Usually develop within 4 months after ingestion of caustic substances 1
• Often more severe and refractory to treatment than other stricture types 1

Radiation-Induced Strictures

• Progressive dysphagia developing months to years after radiation therapy 1
• Often accompanied by xerostomia (dry mouth) and other radiation side effects 4

Eosinophilic Esophagitis

• Can present with "small-caliber esophagus" causing dysphagia in younger patients 5
• Food impaction is common 1
• May have concurrent allergic conditions 1

Warning Signs Requiring Urgent Evaluation

• Sudden worsening of dysphagia - May indicate progression of stricture or development of malignancy 1
• Complete inability to swallow liquids - Suggests severe narrowing requiring urgent intervention 1
• Persistent chest pain after dilatation - May indicate perforation, a serious complication 1
• Fever, breathlessness, or tachycardia after procedures - Signs of potential perforation requiring immediate evaluation 1

Diagnostic Considerations

• Barium esophagram and endoscopy are essential to confirm diagnosis and differentiate between benign and malignant strictures 3
• Endoscopic biopsies should be performed to exclude malignancy, particularly in older patients with new-onset symptoms 3, 2
• Patients with dysphagia should be evaluated promptly as symptoms may indicate serious underlying pathology 1

Remember that patients with long-standing strictures may adapt to their symptoms and underreport them, particularly those with congenital conditions like esophageal atresia 1. Any new or worsening dysphagia should prompt immediate investigation to rule out complications or malignancy.