Radiologic Diagnosis of Benign Esophageal Strictures: A Pattern Approach

Abstract

Benign esophageal strictures are a leading cause of dysphagia. Therefore, radiologists have an important role in detecting esophageal strictures and determining their cause. The most common cause of strictures in the distal esophagus is gastroesophageal reflux disease. Reflux-induced ("peptic") strictures may be associated with sacculations, fixed transverse folds, or esophageal intramural pseudodiverticula. In addition, scleroderma, nasogastric intubation, Zollinger-Ellison syndrome, and alkaline reflux esophagitis may be associated with stricture formation in the distal esophagus. Upper and midesophageal strictures may be caused by Barrett esophagus, mediastinal irradiation, ingestion of drugs or caustic substances, congenital esophageal stenosis, skin diseases, or esophageal intramural pseudodiverticulosis. Other unusual causes of esophageal stricture formation include Crohn disease, Candida esophagitis, graft-versus-host disease, eosinophilic esophagitis, Behçet disease, endoscopic sclerotherapy for esophageal varices, and glutaraldehyde contamination at endoscopy. Esophageal strictures are best evaluated with biphasic esophagography that includes both single- and double-contrast spot images. When esophageal strictures are detected at barium examination, the underlying cause can often be determined with a pattern approach that takes into account the clinical history, the appearance and location of the strictures, and the presence of other associated radiographic findings.

Imaging of the oesophagus: beyond cancer

“…5). In general, strictures in the upper and middle regions of the oesophagus tend to be caused by post-radiation changes, caustic ingestions, Barrett oesophagus, medication side effects, and various skin conditions; causes in the lower oesophagus generally include gastroesophageal reflux, scleroderma, Barrett oesophagus, and nasogastric tube placement [13]. Please note that diffuse oesophageal spasm, with its classic corkscrew appearance of the oesophagus, may mimic stricture, however these points of narrowing should not be persistent over time.…”

Diagnosis and initial management of Gastroesophageal complications

“…Less frequent etiologies include eosinophilic oesophagitis, NSAID use, chest irradiation, and esophageal variceal sclerotherapy and others (Table 2) [9]. In the past few years the prevalence of eosinophilic oesophagitis has been increasing in the adult population and this diagnosis should be ruled out in especially young men with food impaction and dysphagia [10].…”

Gastro�sophageale Refluxkrankheit

“…Die Röntgenuntersuchung ist den anderen Methoden hinsichtlich Sensitivität und Spezifität unterlegen [30,48,49]. Wichtige Zusatzinformationen bringt das Barium-Kontrast-Röntgen bei der Frage nach dem Vorliegen einer Hernie oder von Stenosen [24,35,37,49]. Die präope-rative Röntgenuntersuchung wird seitens der European Association for Endoscopic Surgery als obligat angesehen.…”