What are the different types of esophageal strictures or constrictions?

From the Guidelines

The esophagus has three normal anatomical constrictions that are clinically significant, located at the cricopharyngeal muscle, the aortic arch and left main bronchus, and the gastroesophageal junction. These constrictions are important to recognize during endoscopic procedures and when evaluating for potential sites of foreign body impaction, as they can cause more severe injury from swallowed caustic substances and are common sites for esophageal carcinomas to develop 1.

Types of Esophageal Constrictions

• Benign reflux-induced strictures: these are the most common type of stricture and are caused by chronic gastroesophageal reflux disease (GERD) 1.
• Malignant strictures: these are caused by esophageal cancer and are typically more difficult to treat than benign strictures 1.
• Radiation-induced strictures: these can occur after radiation therapy to the chest or neck area 1.
• Corrosive strictures: these can occur after ingestion of caustic substances, such as bleach or acid 1.
• Eosinophilic esophagitis: this is a chronic inflammatory condition of the esophagus that can cause strictures 1.
• Achalasia: this is a motility disorder of the esophagus that can cause dysphagia and regurgitation of food 1.

Clinical Significance

Understanding the different types of esophageal constrictions is important for clinicians to interpret symptoms of dysphagia and guide diagnostic and therapeutic interventions for esophageal disorders 1. The location and severity of the stricture can affect the treatment approach, with some strictures requiring dilatation, stenting, or surgery 1.

Treatment Approaches

• Oesophageal dilatation: this is a common treatment approach for benign strictures, and can be performed using balloon dilatation or bougie dilatation 1.
• Stenting: this can be used to treat malignant strictures or other types of strictures that are not responsive to dilatation 1.
• Surgery: this may be necessary for some types of strictures, such as those caused by achalasia or eosinophilic esophagitis 1.

From the Research

Types of Esophageal Constrictions

• Peptic esophageal stricture: a common sequelae of long-standing reflux esophagitis, occurring in approximately 10% of patients with gastroesophageal reflux disease seeking medical evaluation 2
• Anastomotic stricture (AS): a potential complication after reconstructed esophageal atresia, with an incidence of 42-43% in infants undergoing primary surgical anastomosis 3

Characteristics of Esophageal Constrictions

• Peptic esophageal stricture:
  • Typically occurs in older patients with a longer duration of reflux symptoms 4, 2
  • Often associated with abnormal esophageal motility and lower lower esophageal sphincter pressures 4
  • May be graded as mild, moderate, or severe, with severe strictures requiring forcible dilatation with bougies 5
• Anastomotic stricture (AS):
  • May occur after reconstructed esophageal atresia, with a prevalence of 42-43% in infants 3
  • May require balloon dilation, with a median number of dilations required being 3 per patient 3

Treatment and Management of Esophageal Constrictions

• Peptic esophageal stricture:
  • Medical therapy with proton pump inhibitors may reduce the need for repeated dilations and provide symptom relief and better clinical outcome 6
  • Endoscopic dilation and surgical intervention are also therapeutic options 6, 4
• Anastomotic stricture (AS):
  • Prolonged use of proton pump inhibitors as stricture prophylaxis may not reduce the incidence of AS, but may delay the initial balloon dilation procedure 3