Dilation of Strictures in New Jersey
Digestive Health & Nutrition Center of Lawrenceville, New Jersey treats esophageal strictures using dilation. Our very own Angela Merlo, M.D. performs this procedure for residents in and around Trenton and Princeton.
What is an Esophageal Stricture?
As part of the digestive system, the esophagus is a narrow muscular tube that starts at the back of the throat and ends at the opening of the stomach. At each end of the esophagus is a sphincter muscle that is normally closed. When you swallow, the first sphincter muscle opens, allowing food, liquids and saliva to enter the esophagus. Involuntary contractions of the muscles of the esophagus move the contents toward the stomach. A second sphincter muscle opens to allow the contents of the esophagus to empty into the stomach, and the sphincter muscle closes to prevent stomach acid, food and liquids from traveling back up the esophagus.
The term “stricture” describes the narrowing of the esophagus that may lead to a person having problems swallowing, a condition known as dysphagia. As the contents of the esophagus pass through the narrowed section, the stricture may cause a sensation of pressure in the chest and difficulty breathing. Symptoms normally pass quickly in mild cases of strictures. When the stricture is more advanced, a person may require medical intervention, as the condition can cause other serious medical issues.
What Causes Esophageal Strictures?
“Stricture” is a general medical diagnosis that requires further evaluation to determine the exact cause. Most patients, especially those over 40 years old, experience benign strictures. Although these strictures are not cancerous, the narrowing of the esophagus still requires treatment. Benign strictures develop as the result of scar tissue inside the esophagus that results from chronic inflammation and damage caused by gastroesophageal reflux disease (GERD) or peptic esophagitis. Both of these conditions result in digestive acid escaping the stomach and entering the esophagus. Over time, scar tissue builds along the walls of the esophagus due to the chronic cycle of irritation and healing. Scar tissue not only develops in various sections of the esophagus but also on top of old scar tissue. The building up of scar tissue is what creates the benign stricture, or narrowing of the esophagus.
When the benign stricture occurs in the area where the esophagus and stomach join, the condition may be described as a Schatzki ring, named after the physician who first documented the condition. As the ring narrows, food is trapped inside the esophagus. The food may pass into the stomach, or the person may need to induce vomiting to dislodge the food.
Benign strictures may also be caused by:
- Damage caused by ingesting toxic substances or exposure to radiation
- Slow thickening of the tissue, typically in the lower section of the esophagus (achalasia)
- Surgical scarring
- Congenital membranous webs (diaphragms), typically in the upper section of the esophagus
Having trouble swallowing does not always indicate the presence of a stricture. Dr. Merlo will determine if you have another condition that is making it difficult to swallow, such as:
- Irregular involuntary muscle movements inside the esophagus (spastic motility disorders)
- Vascular or neurological conditions
- Bulging sacs along the walls of the esophagus (diverticulums)
- Certain muscular disorders, such as myasthenia gravis and muscular dystrophy
Esophageal Cancer and Strictures
Approximately 11,000 new cases of esophageal cancer are diagnosed each year, primarily among adults who regularly consumed alcohol or smoked early in life. Esophageal cancer also affects African Americans more than other ethnicities, and the majority of cases are amongst men. Cancer of the esophagus typically occurs in the lower section, but malignancies can develop anywhere in the organ.
One in ten people with GERD develop Barrett’s esophagus, a condition in which the lining of the esophagus undergoes structural changes due to the persistent presence of stomach acid. The condition increases your risk of developing esophageal cancer. Dr. Merlo takes a biopsy of the tissue inside the esophagus to diagnose Barrett’s esophagus. If you have the condition, she will recommend periodic upper endoscopies to monitor for signs of cancer.
What is the Treatment for an Esophageal Stricture?
If Dr. Merlo notes a benign esophageal stricture during your upper endoscopy, the built-up tissue is removed as part of the procedure. You are sedated during the endoscopy with medications from an IV drip. Dr. Merlo feeds a long, flexible, slender tube into your mouth and down your esophagus. The tube has a very tiny camera and light that allows her to visually inspect your esophagus. She moves the endoscope very slowly to inspect each area of tissue.
Dr. Merlo uses one of two techniques to remove strictures. The first technique involves using a balloon on the endoscope to dilate, or open the esophagus. If the balloon does not provide adequate improvement, she may use a Maloney or Savary dilator, both of which are larger than the balloon.
Cancerous growths may be removed immediately if the lesions are small enough. If the cancer has spread or is too large for surgical removal, Dr. Merlo discusses other treatment options, such as radiation, chemotherapy, tumor probes, laser treatments, stents and other mechanisms for opening the esophagus.
If you are a resident of Trenton or Princeton, New Jersey, who is in need of treatment for esophageal strictures, dilation may be a treatment option. Contact the Digestive Health & Nutrition Center in Lawrenceville to discuss the procedure.
