Peptic esophageal stricture: a report from Argentina

Abstract

Peptic esophageal stricture (PES) is a major complication of gastroesophageal reflux disease. The aims of this paper were to determine the characteristics of these patients with regard to demography, morphology, functional status and results of therapy. The charts of the patients treated at our service who underwent esophageal dilatation for PES between 1971 and 1998 were reviewed. Statistical analyses were performed by means of chi2, Mann-Whitney and Student's t-tests. One hundred and thirty-five patients with PES were dilated by various means. The mean age was 61.1 +/- 16.3 years, the ratio of men to women was 2.75/1 and mean duration of symptoms was 44.4 +/- 74.6 months. Their symptoms were dysphagia in 100%, pyrosis in 70%, and regurgitation in 40% of the cases. There was an average weight loss of 3.3 +/- 6 kg. The upper gastro-intestinal series showed pre- and post-dilatation diameters at the stricture of 8 +/- 2.5 mm and 15.9 +/- 1.2 mm, respectively. The stricture was located at the lower third of the esophagus in 97% and at the middle third in 3% of the cases. We found PES endoscopically in all instances, with different degrees of erosions in 64%, ulcers in 20% and Barrett's esophagus in 16% of the cases. The biopsy samples showed intestinal metaplasia in 16% and esophagitis in 75.5%, being normal in the remaining 8.5%. Brush cytology was negative for malignancy in 100% of the cases. Esophageal manometry showed peristaltic wave amplitude of 40 +/- 3 mmHg and presence of peristaltic waves of 62 +/- 38.6%. LES pressure was 8.6 +/- 6.3 mmHg (NV 24.2 +/- 6.3 mmHg). Measurement of pH showed 15% of patients had pH < 4. Patients needed a mean of 4.7 +/- 1.6 dilations per case, with successful results in 87.2% of cases. The perforation rate was 0.1% of the total number of procedures and 0.7%, of patients. The mortality rate was 0.7% (one case). We observed PES relapse in 32% of the cases. There was no correlation between relapse, age, duration of the stenosis or pharmacological treatment with H2 blockers or proton pump inhibitors. We conclude that in Argentina, demography, morphology, functional status and results of dilatation of PES patients are similar to those reported in the Western world, with the exception of the different behavior seen after treatment with H2 blockers or proton pump inhibitors.

A Study on Dysphagia Due to Benign Oesophageal Strictures

“…The incidence of various symptoms were dysphagia 100%, regurgitation 45%, epigastric or substernal pain 35%, weight loss 25% and cough in 12% cases, which are comparable with study of Mazzadi SA [11] (2004) in which dysphagia (100%), regurgitation (40%) and epigastric pain (30%). Similar results were found in study of Ghoshal UC [6] (2004) with dysphagia (100%), regurgitation (48%), epigastric pain (17%), weight loss (26%) and pulmonary symptoms occurred in 18% cases.…”

“…The study of Mazzadi SA [11] (2004) on peptic stricture shows 97% of stricture present in lower one third of oesophagus. Chiu YC et al (2013) reported that, of the 18 patients with oesophageal stricture alone, 6 had orifices of strictures located in the upper third of the oesophagus, 6 in the middle third and 6 in the lower third.…”

“…In peptic stricture, patients were of 61.1 ± 16.3 years and 56.1 years (range 32-82 years) in Mazzadi SA [11] (2004) and Chiu YC [12] (2004), respectively.…”

Diagnosis dan Penatalaksanaan Striktur Esofagus

“…5,6 Wienbeck 7 (1989) juga melaporkan bahwa insiden peptic esophageal stricture meningkat di Jerman yaitu sekitar 10-20%. Mazzadi 8 di Argentina (2004) melaporkan insidennya sekitar 0.8% dari seluruh pasien GERD dengan rata-rata umur 44-77 tahun dan lebih sering pada laki-laki dibanding wanita dengan rasio 2,7:1.…”

“…Peptic esofageal sricture merupakan salah satu komplikasi jangka panjang dari GERD. 8 Sekitar 40-65% kasus GERD akan berkembang menjadi esofagitis erosif dan bila tidak diobati sekitar 4-23% esofagitis erosif ini akan berkembang menjadi striktur esofagus. 6 Faktor predisposisi terbentuknya striktur ini tidak begitu jelas, tapi beberapa studi menerangkan bahwa peptic esophageal stricture dapat terjadi pada refluks yang lama, adanya kelainan motilitas esofagus dan tekanan spingter bawah esofagus yang rendah.…”