In those patients who develop a stricture, the lower oesophageal sphincter pressure, oesophageal motility and gastric emptying are more severely impaired than in those patients with GORD who have not developed this complication. Peptic strictures usually present with dysphagia that is often confined to solids. In advanced cases dysphagia to liquids may occur. Symptoms usually develop slowly and the the degree of weight loss seen in patients with malignant strictures is not often seen. Symptoms of heartburn and regurgitation may improve as a stricture develops and provides a barrier to further reflux episodes.
Urgent investigation is required.
A barium swallow should initially be performed. It will provide information on the site and extent of any stricture and may give a clue as to the underlying aetiology. This should be followed by endoscopy to determine the cause of the stricture and to allow biopsy of any mucosal lesion. Peptic strictures usually have a smooth mucosal surface. The presence of any irregularity should raise concerns of possible malignancy.