Oesophageal Stricture

Description

An oesophageal stricture is an abnormal circumferential narrowing of the lumen secondary to severe oesophagitis. A deep wall injury results followed by healing by fibrosis. The most important causes are:

• Chemical injury from swallowed substances
• Gastro-oesophageal reflux
• Foreign bodies
• Oesophageal surgery
• Neoplasia
• Oesophageal abscesses

Diagnosis

Clinical Signs

Depend on the severity and extent of the stricture but include:

• Regurgitation shortly after feeding (may then attempt to re-ingest the regurgitant)
• Anorexia
• Weight loss
• Malnutrition
• Ptyalism
• Aspiration pneumonia (with associated pulmonary signs such as wheezing and crackling on lung auscultation)
• Liquid food better tolerated than solid food.

Diagnostic Imaging

Fibrosing strictures must be differentiated from vascular ring anomalies, oesophagitis, intraluminal and extraluminal masses. This can be done with survey and contrast radiography, endoscopy and ultrasonography.

Survey radiographs are usually unremarkable in animals with benign oesophageal strictures. Barium contrast radiography is normally diagnostic of the disorder and may demonstrate:

• Segmental or diffuse narrowing of the oesophagus
• Oesphageal dilatation proximal to the site of the stricture

Ultrasonography is not usually useful in diagnosing small benign strictures but may visualise those caused by mass compression.

Oesophagoscopy is used for a definitive diagnosis. It should be used to confirm the site and severity of the stricture and also to exclude the presence of an intraluminal mass.

Treatment

Mild oesophagitis:

• withdraw oral food for 2-3 days and manage as an outpatient.

More severe oesophagitis:

• may need admitting to the hospital, Nil Per Os and animal may require enteral or parenteral nutritional support.

Drugs:

• oral sucralfate suspension
• gastric acid secretory inhibitors (e.g. ranitidine, omeprazole) can be useful in cases of gastro-oesophageal reflux
• broad spectrum antibiotics in animals with sever oesophagitis or aspiration pneumonia
• analgesics

Prognosis

Mild oesophagitis has a good prognosis whereas ulcerative oesophagitis and animals suffering from aspiration pneumonia have a more guarded prognosis.

References

Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition) BSAVA

Merck & Co (2008) The Merck Veterinary Manual