Anatomically this makes sense, because the stricture actually provides a barrier to acid refluxing into the esophagus. This phenomenon can occur with any distal esophageal stricture and does not suggest either a benign or malignant process. They may both be present in any one patient. These patients continue to have a good appetite and will alter their diet to soft or liquid so that they are able to maintain adequate nutrition. PPIs have been shown to not only heal the esophagitis associated with strictures, but also to decrease the need for repeat stricture dilations.
Esophageal dilation is a relatively quick and simple procedure with a low complication rate.
In order to undergo antireflux surgery, a patient must also have adequate esophageal motility and adequate gastric emptying. It is important to remember that patients with GERD-induced strictures are more likely to have motility disorders than GERD patients who do not have strictures. Increasing the dose of PPIs is indicated if this patient is not already on maximum therapy, but he still needs to have repeat EGD with dilation. Click here to return to Case Presentations, Questions, and References Click here to print this page.