Esophageal strictures – causes, symptoms, treatment
Strictures (stenosis) of esophagus are decreases of esophageal caliber arising from processes of healing at this level making the esophageal wall an inextensible tissue scar.
Regarding the etiology of these scar processes from esophageal level, they are usually the consequence of various types of esophagitis (inflammation of the esophagus).
The esophageal inflammation (esophagitis) may occur after ingestion of caustic substances, following the action of viruses and microbes that cause infectious diseases (herpes zoster, diphtheria, smallpox), it can meet specific esophageal chronic inflammations (TB, syphilis, actinomycosis ) and necrotizing processes of the esophageal wall.
The most common type of esophagitis occurs after ingestion of caustic chemicals like caustic soda, sulfuric acid, acetic acid, chromic acid, corrosive poisons.
These lesions evolve in three phases with a specific symptomatology for each evolutionary stage.
The first phase is characterized by a progressive edematous swelling with increased esophageal mucosa secretion, the second phase is the ulceration phase which is characterized by esophageal tissue necrosis which is removed, the third phase is the phase of scarring that makes the esophagus a fibrous cord, inextensible.
Symptoms. Clinically, during the first hours and days after intoxication, postcaustic esophagitis is characterized by severe esophageal burns associated with buco-pharyngeal burns which make swallowing impossible, can be added pain, dehydration and possible perforation complications. Later appears salivation (salivary secretion in large amount), salivary regurgitation with streaks of blood and removal of necrotizing tissue.
After the acute phase of intoxication is installed apparent healing phase that may last from several weeks to a year, during which the swallowing is almost normal for both solid and liquid food.
Gradually, the patient may refer to the difficulty in swallowing solid foods, such swallowing difficulties are setting up later for liquid and semi-liquid food. Salivation is abundant.
General signs of the disease are more severe as the strictures have small-caliber. Thus, these patients can easily make a series of infections, especially pulmonary. Over time, because they can not feed, these patients are malnourished and dehydrated. If the stricture is located above, fluids will be expelled through the mouth and nose immediately after swallowing.
To confirm the diagnosis of esophageal stricture the following investigations are made:
– CBC – with changed values if bleeding occurs;
Treatment of esophageal strictures can be conservative dilator or surgical, which is indicated only in complete or cvasicomplete obliteration of the esophagus, when dilator treatment no longer works.