Esophageal Strictures

Overview

What is an esophageal stricture?

An esophageal stricture is an abnormal tightening or narrowing of the esophagus.

Your esophagus is a muscular tube that connects the throat to the stomach, carrying food and liquid. A stricture narrows the esophagus, making it more difficult for food to travel down the tube. In severe cases, even drinking liquid can be difficult.

Esophageal strictures can be:

  • Cancerous: These strictures get worse quickly.
  • Benign (not cancerous): Benign strictures tend to progress slowly.

What are the types of esophageal strictures?

Strictures may be simple or complex:

  • Simple strictures are smaller, leaving a wider opening in the esophagus. They are usually straight and symmetrical. Their surfaces and margins (borders) are smooth.
  • Complex strictures are longer and leave a narrower opening. They are not straight or symmetrical and have uneven surfaces and margins.

How does an esophageal stricture affect me?

People with esophageal strictures may have pain or difficulty swallowing.

Who is at risk for esophageal strictures?

Risk factors for esophageal strictures include:

Are esophageal strictures common?

Esophageal strictures are not common. They can occur at any age but usually affect people older than 40 years.

Symptoms and Causes

What causes esophageal strictures?

Conditions or treatments that cause inflammation or scarring in the esophagus can lead to strictures:

  • Eosinophilic esophagitis: This allergic reaction/immune system problem causes inflammation in the esophagus, possibly leading to strictures.
  • Esophageal cancer: When abnormal cells divide or grow out of control in esophageal tissue, the tumor can cause strictures.
  • Gastroesophageal reflux disease (GERD): With GERD, stomach acid can flow backward. The acid damages the lining of your esophagus. This type of stricture is called a peptic stricture.
  • Radiation therapy: Treatment for cancer in the head, neck or chest can cause strictures up to a year and a half later.
  • Surgery: A procedure in the esophagus can leave inflammation and scarring, causing a stricture.
  • Other causes: Ulcers, some medications (for example, some antibiotics and non-steroidal anti-inflammatory drugs), certain infections and accidentally swallowing chemicals can also cause strictures.

What are the symptoms of an esophageal stricture?

An esophageal constriction may cause:

  • Burning sensation in the neck or throat.
  • Difficulty swallowing (dysphagia).
  • Feeling of food getting stuck in your throat.
  • Frequent episodes of choking.

Talk to a healthcare provider if you experience any of these symptoms. Strictures can lead to malnutrition and dehydration. Your provider can figure out what’s causing the strictures, so you get the right treatment and feel better.

Diagnosis and Tests

How is an esophageal stricture diagnosed?

Your healthcare provider asks you about your symptoms and medical history and performs a physical exam. Other tests can confirm a diagnosis.

What are the tests for esophageal strictures?

These tests can help confirm an esophageal stricture:

  • X-ray with barium: You swallow a solution containing barium. Then your provider takes X-rays of your neck and chest. As the barium travels down the esophagus, it highlights any problems so your provider can see them on the X-ray.
  • Ultrasound: Detailed images can measure how thick the esophageal wall has become, which shows how much it is narrowing the esophagus.
  • Endoscopy: A healthcare provider inserts an endoscope into your mouth and down your throat. The tool is a thin and flexible tube with a light and camera at the end. The healthcare provider can examine your esophagus. If needed, your provider can take a small piece of tissue to be tested for cancer (biopsy).
  • Esophageal manometry: This test examines the esophageal muscles and sphincter. A small catheter tube is inserted into the nose and into the esophagus. This catheter measures the muscle and valve function of the esophagus during the swallow.

Management and Treatment

How are esophageal strictures treated?

Esophageal dilation is the most common treatment for strictures. Your provider uses a balloon or dilator (a long plastic or rubber cylinder) to widen the narrow area of the esophagus.

What happens during esophageal dilation?

Before the procedure, your healthcare provider gives you sedatives to help you relax and reduce pain. Your provider will also numb your throat. If you have GERD, you may receive medication that makes your body produce less acid.

Then your provider inserts an endoscope down your throat and into your esophagus. The goal of the procedure is to insert either:

  • A balloon to stretch the area.
  • Plastic or rubber dilators of bigger and bigger sizes to stretch the area.

Some patients with complex strictures may also receive metal esophageal stents to prop open strictures.

What happens after esophageal dilation?

A dilation procedure is an outpatient treatment. You can go home once the medicines wear off. Your healthcare provider may tell you to avoid eating, drinking, working or driving for a period of time. They may also prescribe medications to control acid at home.

Your provider will discuss your schedule of follow-up appointments with you. Be sure to stick to the follow-up schedule to make sure you’re healing well and that there are no complications.

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Prevention

How can I prevent strictures?

GERD is the most common cause of esophageal strictures. Certain lifestyle changes can help you control GERD and prevent or delay strictures:

  • Avoid spicy, fatty, tomato-based or citrusy foods and caffeinated or carbonated beverages.
  • Don’t drink alcohol.
  • Don’t smoke.
  • Eat smaller meals, and don’t eat for a few hours before bedtime.
  • Elevate your pillow when you rest or sleep.
  • Maintain a healthy weight.

Outlook / Prognosis

What’s the outlook for people with esophageal strictures?

Most symptomatic strictures require dilation to fix the problem. Many patients need more than one dilation over time to keep the esophagus wide enough for food to pass through.

In rare cases, severe and untreated esophageal strictures can cause perforations (small rips), which can be life-threatening. Don’t delay seeing your provider about any swallowing problems.

Will I need more than one treatment?

Your healthcare provider may need to repeat the dilation procedure to stop your esophagus from narrowing again.

Living With

How can I take care of myself if I have an esophageal stricture?

If you have a stricture, see a healthcare provider. They can determine how narrow your esophagus is and treat any underlying conditions, such as GERD.

Your healthcare provider will probably recommend lifestyle changes and healthy food choices. Follow those recommendations to ease your symptoms and reduce your chances of choking.

If you have a dilation procedure, follow your healthcare provider’s instructions afterward. Always take your medications as prescribed and attend follow-up appointments.

When should I call my healthcare provider?

Call your provider if you:

  • Have asthma-like symptoms.
  • Breathe in pieces of food.
  • Get food stuck in your throat.
  • Have severe chest pain.

What else should I ask my healthcare provider?

If you have an esophageal stricture, consider asking your healthcare provider:

  • What is causing my stricture?
  • How can I treat the cause?
  • Do I need to have my esophagus stretched?
  • What can I do to feel better?
  • Are there certain foods I should eat or avoid?

A note from Cleveland Clinic

  • Esophageal strictures can make it feel like food is stuck in your throat. Severe cases can lead to choking episodes, breathing problems, malnutrition and dehydration. Talk to your healthcare provider if you have any trouble swallowing or breathing. If you have an esophageal stricture, dilation can help. Attend all of your follow-up appointments after treatment.

Last reviewed by a Cleveland Clinic medical professional on 11/27/2020.

References

  • Agarwalla A, Small AJ, Mendelson AH, et al. Surg Endosc. 2015;29:1903-1912. Accessed 12/1/2020.Risk of Recurrent or Refractory Strictures and Outcome of Endoscopic Dilation for Radiation-Induced Esophageal Strictures. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4385000/)
  • American Society for Gastrointestinal Endoscopy. Accessed 12/1/2020.Understanding Esophageal Dilation. (https://www.asge.org/home/for-patients/patient-information/understanding-eso-dilation-updated)
  • Government of Alberta. Accessed 12/1/2020.Learning About Esophageal Stricture. (https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=abs2893)
  • Desai, Jay P., Moustarah, Fady. [Updated 2020 June 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Accessed 12/1/2020.Esophageal Stricture. (https://www.ncbi.nlm.nih.gov/books/NBK542209/)

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