Esophageal strictures involve abnormal narrowing or tightening of the esophagus. They vary in length and severity, ranging from mild constriction to complete obstruction, and are classified as benign (noncancerous) or malignant (cancerous).

Etiology

The primary cause of esophageal strictures is long-standing gastroesophageal reflux disease (GERD), accounting for about 70 to 80% of adult cases. Chronic acid reflux can lead to injury and scarring of the esophageal lining, culminating in strictures.

Ingestion of household cleaning products, accidental or deliberate, can cause esophageal injury ranging from minor to severe, often resulting in strictures due to full-thickness necrosis.

Radiation therapy, a standard treatment for head, neck, and lung cancers, can lead to radiation-induced esophageal strictures as a long-term complication. The targeted radiation in cervical or thoracic regions can damage surrounding soft tissues, including the esophagus, with strictures typically developing within a median of 6 months post-treatment.

Malignant tumors in the esophagus can infiltrate its layers – the mucosa, submucosa, muscularis propria, and adventitia. Tumor growth within these layers leads to scarring, fibrosis, and subsequent narrowing of the esophagus. Additionally, tumors in adjacent organs or lymph nodes can exert external pressure, causing further constriction.

Eosinophilic esophagitis is another cause, where eosinophils accumulate in the esophagus, causing inflammation, constriction, and strictures due to an allergic response.

Risk factors

Other potential causes of esophageal strictures include congenital abnormalities, prolonged nasogastric tube use, long-term NSAID medication use, and post-surgical complications such as those following fundoplication for GERD.