What are the other Names for this Condition? (Also known as/Symptoms)

• BES (Benign Esophageal Stricture)
• Benign Oesophageal Stricture
• Esophageal Stricture

What is Benign Esophageal Stricture? (Definition/Background Information)

• Benign Esophageal Stricture (BES) is a condition in which the esophagus becomes tighter or narrower anywhere along its length. This results in swallowing and breathing difficulties, among other medical issues
• The esophagus is a tube that connects the mouth to the stomach. It forms a part of the upper gastrointestinal tract and is also known as the ‘food-pipe’. Benign Esophageal Stricture is usually caused by the chronic condition gastroesophageal reflux disease (GERD)
• Due to longstanding GERD, the esophagus is injured as a result of stomach acids or other toxins destroying the esophageal lining. The part of the esophagus lining that becomes inflamed, causes a reduction in the effective cross-sectional area of the esophagus (esophagus diameter), resulting in associated symptoms
• The common signs and symptoms of Benign Esophageal Stricture include trouble swallowing, heartburn, and acid reflux. The condition can be detected using a variety of test such as a barium swallow test, endoscopy, and esophageal pH monitoring test
• Benign Esophageal Stricture can be treated with medications, stent placement, surgery, and lifestyle modifications. With adequate treatment, the prognosis is generally good in a majority of cases
• One of the effective methods to prevent Benign Esophageal Stricture is to avoid foods and beverages that can cause damage to the esophagus. It is also important to diagnose and treat any underlying medical condition early

Who gets Benign Esophageal Stricture? (Age and Sex Distribution)

• Individuals of any age and gender are prone to Benign Esophageal Stricture
• Individuals with gastroesophageal reflux may develop the condition after they reach age 40 years
• The condition is seen worldwide among all racial and ethnic groups

What are the Risk Factors for Benign Esophageal Stricture? (Predisposing Factors)

The risk factors for Benign Esophageal Stricture may include:

• Frequently consuming a large amount of foods that are known to cause acid reflux (gastroesophageal reflux) such as:
  • Spicy foods
  • Fatty foods
  • Chocolates
  • Caffeine products
  • Citrus-based foods
  • Carbonated drinks
• Drinking too much alcohol, which can lead to esophageal varices that requires surgery
• Smoking
• A variety of autoimmune disorders
• Consuming corrosive substances and chemicals
• Medical conditions involving the gastrointestinal tract such as Crohn’s disease, hiatal hernia, and esophageal motility disorder
• Medical procedures involving the esophagus, including placement of feeding tubes
• Eating less than two or three hours before going to bed
• Treatment of cancer that involves radiation therapy or chemotherapy to the throat or esophagus

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Benign Esophageal Stricture? (Etiology)

A Benign Esophageal Stricture develops when there is a constant irritation of the esophageal surface lining resulting in an inflammation. There are a variety of medical conditions and external factors that can result in the condition including:

• Gastroesophageal reflux disease (GERD): The most common cause of Benign Esophageal Stricture is GERD, a chronic condition in which the stomach contents backs up into the esophagus/food-pipe. It is reported that between 7-23% of untreated individuals with GERD can develop an Esophageal Stricture
• Eosinophilic esophagitis: It is a condition in which white blood cells buildup in the esophagus, resulting in a chronic autoimmune disease 
• Injury caused while using an endoscope, to examine the gastrointestinal tract for other medical reasons
• Using a nasogastric (feeding) tube for a long period
• Esophagectomy, which is a surgical procedure involving the esophagus that may result in stricture formation as a post-operative complication
• Strictures may also develop from scar tissue formation, following laser or photodynamic therapy to the esophagus
• An Esophageal Stricture may develop from a dysfunctional esophageal sphincter due to a variety of medical causes
• Hiatal hernia: It occurs when the upper portion of the stomach (or any abdominal structure other than the esophagus) enters into the chest cavity
• Esophageal motility disorder: A condition in which individuals have difficulty in swallowing food that may be due to certain food allergies
• Ingesting toxic materials, such as cleaning products or batteries, or other substances that may harm the esophageal lining
• Lye ingestion; lye is a caustic chemical that is used in soap making, unclogging drains, as floor disinfectant, etc.
• Taking very hot or very cold liquids leading to thermal injury to the esophagus
• Benign Esophageal Stricture is commonly observed in individuals who receive treatment for esophageal varices, due to scar tissue formation
• It can also occur after radiation therapy or chemotherapy to the chest or neck region
• Scleroderma, a chronic connective tissue disorder of unknown cause that commonly affects young and middle-aged women
• Plummer-Vinson syndrome: A rare condition that involves swallowing difficulties due to small growths within the esophagus, which block the flow of food to the stomach. These small and benign web-like growths occur in the upper part of the esophagus
• Schatzki ring: A condition that is characterized by a narrowing of the esophagus, due to benign growths in the lower part of the esophagus
• Graft versus host disease
• Inflammatory bowel disease (IBD) such as Crohn’s disease
• Cicatricial pemphigoid, which is an autoimmune disease characterized by blistering skin lesions

What are the Signs and Symptoms of Benign Esophageal Stricture?

The signs and symptoms of Benign Esophageal Stricture may include:

• Trouble swallowing or pain while swallowing
• Reflux of food and liquids; food backing up from the stomach to the throat causing bitter taste in the mouth
• Drooling
• Regurgitation of food
• Choking sensation
• Coughing, due to sensation that food is stuck in the throat
• Frequent burping or having hiccups
• Heartburn
• Unexpected weight loss

The signs and symptoms, if any, of the underlying condition may be noted.

How is Benign Esophageal Stricture Diagnosed?

The diagnosis of Benign Esophageal Stricture may involve the following:

• Detailed family medical history and complete physical examination
• Assessment of the presenting signs and symptoms
• Barium swallow test: A liquid with barium is swallowed that coats the esophagus lining; this allows X-rays of the esophagus to be taken 
• Esophageal pH testing: A tube is placed in the esophagus for 24 hours. The test measures the amount of stomach acid that comes into the esophagus and its pH value
• Upper GI endoscopy: An endoscope (tube with a camera) is passed through the mouth into the esophagus to view the region. Tissue samples for a biopsy may be collected, if required

Additional tests and procedures may be considered by the healthcare provider in order to diagnose the underlying cause of Esophageal Stricture.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Benign Esophageal Stricture?

The complications of Benign Esophageal Stricture may vary depending on the underlying cause of the condition.

• Typically, some individuals with Esophageal Stricture will experience complications such as severe/acute swallowing difficulties and breathing difficulties
• If left undetected or untreated, chronic swallowing difficulties can also lead to weight loss due to malnutrition and dehydration
• Pulmonary aspiration: Vomitus (vomited materials), food, or fluid could possibly enter the lungs; this can be a major complication causing the lungs to become inflamed and function abnormally
• Recurrence of the condition following treatment is known to take place

How is Benign Esophageal Stricture Treated?

The treatment measures for Benign Esophageal Stricture are dependent on the underlying cause and may include:

• Undertaking a treatment of gastroesophageal reflux (GERD)
• Modifying certain diet and lifestyle factors:
  • Eating smaller meals
  • Avoiding food a few hours (2-3 hours) before bedtime
  • Completely avoiding smoking
  • Avoiding alcohol 
  • Limiting food and beverages that are more likely to cause acid reflux
  • Elevating pillow (while sleeping) to prevent acid reflux
• Medications: Certain acid-blocking medications (called proton pump inhibitors), such as omeprazole, lansoprazole, pantoprazole, and esomeprazole, may be prescribed
• Esophageal stent placement: A thin plastic tube is placed in the esophagus, to keep the passage open to help swallow food and drinks
• Surgery, such as an esophageal replacement, may be considered in case of severe stricture formation
• Esophageal dilation/stretching: An endoscope is inserted into the esophagus; the esophagus is then inflated with a small balloon to help it to stretch

How can Benign Esophageal Stricture be Prevented?

The most effective method to prevent Benign Esophageal Stricture is to avoid foods and drinks that can potentially damage the esophagus. Further, the following preventative measures may be considered:

• Undertaking prompt treatment of any associated/underlying conditions, such as gastroesophageal reflux, autoimmune disorders, or Crohn’s disease
• Inadvertent swallowing of toxic chemicals may be avoided by properly labelling them and keeping them out of reach of children
• Avoid consuming extremely hot or cold substances
• Avoid excessive intake of food and alcohol
• Smoking cessation

What is the Prognosis of Benign Esophageal Stricture? (Outcomes/Resolutions)

In most cases, the prognosis of Benign Esophageal Stricture is good with appropriate treatment, including by availing a prompt treatment of the underlying causative condition.

• Most individuals who undergo esophageal dilation treatment may need it again later in their life
• In some cases, especially in those with GERD, medication may be necessary throughout one’s lifetime to manage the condition
• Rarely, there is the possibility of malnutrition or choking from Esophageal Stricture

Additional and Relevant Useful Information for Benign Esophageal Stricture:

The following article link is a helpful resource for other Digestive Health conditions:

https://www.dovemed.com/healthy-living/digestive-center/