Esophageal Strictures | Overview
An esophageal stricture is a narrowing of the esophagus, the tube that connects the mouth to the stomach. Your child may develop a stricture if they have gastroesophageal reflux or eosinophilic esophagitis, if they have had surgery on their esophagus or if their esophagus is damaged from a caustic injury or other trauma. Some esophageal strictures are present at birth. These are called congenital esophageal strictures. An esophageal stricture can make it difficult for your child to swallow, a problem called dysphagia.
What are the signs and symptoms of esophageal strictures?
The main symptom of an esophageal stricture is difficulty swallowing. Strictures can lead to an inability to tolerate the body's own secretions, as well as feeding refusal, coughing and retching. Strictures can also cause pain when swallowing, regurgitation (spitting up food or liquids) and weight loss. If the stricture is the result of reflux, your child may also have signs of that, such as heartburn, chest pain or a sore throat.
What causes esophageal strictures?
Although some children can be born with congenital esophageal strictures, they are often the result of damage to the esophagus, such as that caused by:
- Prior surgery on the esophagus
- Caustic injuries to the esophagus, which can occur if your child ingests caustic substances such as lye, batteries or household cleaners
- Eosinophilic esophagitis, an inflammatory condition that can trigger symptoms similar to GERD
- Chronic gastroesophageal reflux disease (GERD), which occurs when stomach acid backs up into your child's esophagus. Over time, this acid can damage the lining of the esophagus and lead to the development of scar tissue
How we care for esophageal strictures
Esophageal strictures are typically treated with a procedure called esophageal dilation, during which a physician uses a small balloon to stretch open the scar tissue causing the narrowing in the esophagus. The clinicians in the Esophageal and Airway Treatment Center at Boston Children's Hospital also offer incisional therapy for esophageal strictures that are not resolved by dilatation. In this innovative treatment, a surgeon uses a highly advanced cautery knife to cut the scar tissue in specific ways to help open the stricture.
Esophageal Strictures | Diagnosis & Treatment
How are esophageal strictures diagnosed?
Clinicians diagnose esophageal strictures by asking you or your child about their symptoms and taking a complete medical history. They may also recommend specific tests to check for narrowing of the esophagus, such as:
- Esophagram (also called a barium swallow), in which your child drinks a special contrast liquid that shows up on x-ray and allows the radiologist to see parts of the body clearly
- Endoscopy, in which a thin, lighted tube with a camera is placed through your child's mouth into the esophagus to view the inside of the esophagus
How are esophageal strictures treated?
The first-line treatment for esophageal strictures is dilation (sometimes incorrectly called dilatation). In this procedure, your child's physician will guide an endoscope - a long, thin, flexible tube equipped with lights and a tiny camera — into your child's mouth and esophagus. The doctor will then guide a tiny balloon through the endoscope and into the stricture, inflating it just enough to stretch the scar tissue causing the stricture in the esophagus. A small tube called a stent may also be inserted into the area of the stricture. The stent keeps the esophagus open as the tissue around it heals; it is removed later in a follow-up procedure. Occasionally we will place a sponge in the esophagus to help healing after dilation or incisional therapy.
In cases where dilation is not effective, your child's doctor may recommend surgery.