Medicines for Oesophageal stricture

What it is

An oesophageal stricture is a narrowing of the oesophagus (food pipe), which makes it harder for food and drink to pass down to the stomach. The main symptom is difficulty swallowing (dysphagia), which typically starts with solid foods (which may feel like they stick or are slow to go down), and can progress to softer foods and liquids if the narrowing worsens; there may also be food coming back up, chest discomfort, and, over time, weight loss if eating becomes difficult. Strictures can be "benign" (non-cancerous) or caused by a cancer, which is a crucial distinction. The most common cause of a benign stricture is long-standing acid reflux (GORD), where repeated acid damage leads to scarring and narrowing (a peptic stricture); other benign causes include damage from swallowing a corrosive substance, certain medicines lodging in the oesophagus, previous treatments, radiotherapy, and some other conditions. However, because a narrowing can also be caused by cancer of the oesophagus, and because the outlook is much better when this is found early, difficulty swallowing always needs prompt assessment to identify the cause. Once the cause is known, benign strictures are usually treatable.

How it is treated

Because difficulty swallowing can be a sign of a serious cause, it is assessed promptly, often via an urgent pathway. The key investigation is usually an endoscopy (a camera test), which allows the narrowing to be seen directly, its cause assessed, and samples (biopsies) taken to determine whether it is benign or a cancer — a crucial step. Treatment then depends on the cause. For a benign stricture, the mainstay is stretching (dilating) the narrowing to widen it and relieve the swallowing difficulty — this is usually done during an endoscopy (using a balloon or dilators), and can be very effective, though some strictures need repeated dilations over time. Alongside this, treating the underlying cause is important to prevent it recurring or worsening — most commonly, controlling acid reflux with acid-reducing medicines (such as proton pump inhibitors) for a peptic stricture, and reviewing any responsible medicines. Dietary advice (such as eating slowly, chewing well, and softer foods) helps while the stricture is being treated. Where a stricture is caused by cancer, it is managed by a specialist cancer team, with treatment directed at the cancer. The reassuring message is that a benign oesophageal stricture is usually treatable — by stretching the narrowing and addressing the cause (often acid reflux) — but that difficulty swallowing should always be assessed promptly, because finding a serious cause early makes a big difference.