Long Esophageal Stricture in a Brittle Diabetic

Abstract

Aim:We report a case of atypical esophageal stricture in a young diabetic woman.Background:Diabetes mellitus and gastroesophageal reflux disease (GERD) are two common disorders in modern society.Case report:A young diabetic woman developed a 6-cm-long esophageal stricture. This stricture was refractory to multiple esophageal dilation procedures. She underwent subtotal esophagectomy and had excellent treatment outcome.Conclusion:Gastroesophageal reflux disease can cause severe long esophageal stricture in a brittle diabetic.Clinical significance:Improving the awareness of their association between diabetes and GERD would greatly benefit the day-to-day practice of medicine.How to cite this article: Pak SC, Darr U, Alastal Y, Yoon Y. Long Esophageal Stricture in a Brittle Diabetic. Euroasian J Hepato-Gastroenterol 2017;7(2):191-192.

Unique Case of a Refractory Esophageal Peptic Stricture in an Uncontrolled Diabetic

“…If acid reflux becomes chronic, it can cause repeated esophagitis and eventual scarring of the esophageal mucosa [6]. This can lead to strictures, which are usually shorter than 2 cm and do not extend further than 4 cm from the gastroesophageal junction [6][7][8]. Strictures can cause stenosis of the esophageal lumen and progressive dysphagia, odynophagia, and weight loss [4,5,9].…”

“…Strictures can cause stenosis of the esophageal lumen and progressive dysphagia, odynophagia, and weight loss [4,5,9]. Symptoms improve with proton pump inhibitors and dilation, but 50% of patients will need multiple dilations [2,3,7,8]. Dilation is usually done in increments but there is a 0.1%-0.4% risk of perforation with each treatment [1].…”

“…Stents offer rapid symptomatic relief but are generally reserved for strictures from malignancy and can be displaced, occluded, or lead to fistulas [2,4]. Esophagectomy is the last resort with 5% mortality and 56% risk for postoperative complications [7,8].…”

“…Patients with diabetes are 1.25 times more likely to have acid reflux compared to the general population [7]. They can develop peripheral, autonomic, and visceral neuropathy affecting the motility of the gastrointestinal tract manifesting as esophageal dysmotility and gastroparesis [7,10].…”

“…Patients with diabetes are 1.25 times more likely to have acid reflux compared to the general population [7]. They can develop peripheral, autonomic, and visceral neuropathy affecting the motility of the gastrointestinal tract manifesting as esophageal dysmotility and gastroparesis [7,10]. Retained stomach contents in gastroparesis cause changes in the thoracoabdominal pressure gradient with subsequent relaxation of the lower esophageal sphincter, leading to reflux [11].…”