eMedicine Specialties > Gastroenterology > Esophagus

Esophageal Stricture: Differential Diagnoses & Workup

Author: Rajeev Vasudeva, MD, FACG, Clinical Professor of Medicine, Consultants in Gastroenterology, University of South Carolina School of Medicine
Contributor Information and Disclosures

Updated: Jun 27, 2006

Differential Diagnoses

Achalasia
Esophageal Motility Disorders
Esophagitis
Schatzki Ring

Other Problems to Be Considered

Esophageal malignancy

Workup

Laboratory Studies

  • CBC: Usually, the results on CBC are within the reference range; however, anemia may develop due to chronic bleeding from severe esophagitis or carcinoma.
  • Liver profile: Usually, the findings are within the reference range; however, the findings may be abnormal if metastatic disease in underlying malignancy is present.
  • Complete metabolic panel: This may allow assessment of the nutritional status, especially in conjunction with weight loss.

Imaging Studies

  • Barium esophagram
    • Barium esophagram provides an objective baseline record of the esophagus prior to medical therapy or endoscopic intervention.
    • This study also provides information about the location, length, and diameter of the stricture and the smoothness or irregularity of the esophageal wall (road map).
    • The information obtained can complement endoscopic findings.
    • Lesions, such as diverticula and paraesophageal hernias, that potentially may lead to increased risk of complications during endoscopy can be identified.
    • This study may be more sensitive than endoscopy for detection of subtle narrowings of the esophagus such as those caused by rings and peptic strictures that are greater than 10 mm in diameter.
    • This study has 100% sensitivity with luminal diameter less than 9 mm, and 90% sensitivity with luminal diameter greater than 10 mm.
  • Chest radiograph, posteroanterior (PA) and lateral: Chest radiography should be used as an adjunct if extrinsic compression is considered a possible etiology of esophageal stricture.
  • Computed tomography scan
    • CT scan can be used to stage malignancies that produce esophageal strictures.
    • Accuracy in estimating the depth of tumor invasion is 60-69%.
    • Accuracy in determining spread to other organs is 82%.
  • Endoscopic ultrasound
    • Endoscopic ultrasound (EUS) is the most accurate means of identifying the extent of local invasion of an esophageal malignancy.
    • Accuracy in estimating the depth of tumor invasion in the esophagus is 92%.

Other Tests

  • Twenty-four–hour esophageal pH monitoring: This may be helpful in evaluating and documenting the adequacy of therapy in patients who remain symptomatic despite treatment with PPIs or fundoplication.
  • Esophageal manometry
    • This test is used to evaluate any patient suspected of having esophageal dysmotility.
    • It may be used as a preoperative tool prior to antireflux surgery to evaluate the presence of severe esophageal dysmotility.

Procedures

  • Esophagogastroduodenoscopy
    • This procedure can be used to establish or confirm the diagnosis, to seek evidence of esophagitis, to exclude malignancy, to obtain biopsy and brush cytology specimens, and to implement therapy.
    • It is more sensitive than barium esophagram in the identification of subtle mucosal lesions.
    • Subtle strictures may be missed when smaller and thinner endoscopes are employed, especially in the setting of minimal sedation.

Histologic Findings

Initial histologic changes in the peptic stricture process include edema, cellular infiltration, basal cell hyperplasia, and vascular changes with a slight increase in type III collagen deposition on healing.

If untreated, the process can lead to progressive inflammation and ulceration involving the submucosa and muscularis mucosa. This can lead to damage of the muscular layer and the intrinsic nervous system of the esophagus, resulting in deposition of type I collagen with subsequent formation of scar tissue and stricture formation.

Staging

CT scan and EUS are used mainly to stage malignancies that produce esophageal strictures.

  • CT scan - Sixty to 69% accurate in estimating the depth of tumor invasion and 82% accurate in determining spread to other organs
  • EUS - Most accurate means of identifying the extent of local invasion and 92% accurate in estimating the depth of tumor invasion in the esophagus

More on Esophageal Stricture

Overview: Esophageal Stricture
Differential Diagnoses & Workup: Esophageal Stricture
Treatment & Medication: Esophageal Stricture
Follow-up: Esophageal Stricture
Multimedia: Esophageal Stricture
References
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Further Reading

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Keywords

esophageal stenosis, peptic stenosis, reflux stricture, peptic stricture, postoperative strictures, corrosive strictures, gastroesophageal reflux–induced esophagitis, gastroesophageal reflux disease, dysphagia

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Contributor Information and Disclosures

Author

Rajeev Vasudeva, MD, FACG, Clinical Professor of Medicine, Consultants in Gastroenterology, University of South Carolina School of Medicine
Rajeev Vasudeva, MD, FACG is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, and South Carolina Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Maurice A Cerulli, MD, FACG, Chief, Division of Gastroenterology and Hepatology, Associate Professor of Clinical Medicine, Department of Internal Medicine, Division of Gastroenterology, New York Methodist Hospital, Cornell University
Maurice A Cerulli, MD, FACG is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Medical Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Simmy Bank, MD, Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Assistant Dean for Medical Curriculum, Associate Professor of Medicine, Division of General Internal Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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