Esophageal stricture medical therapy

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Main stay of treatment of esophageal stricture is dilatation.

Proton pump inhibitors also help in prevention of recurrence after surgical esophageal dilatation.

Proton pump inhibitors have been found more effective in acid suppression in these patients as compared to H2 blockers.


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

The mainstay of treatment for esophageal stricture is dilation. Supportive medical therapy for esophageal stricture secondary to gastroesophageal reflux disease includes proton pump inhibitors or H2 antagonists.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

OR   The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

Medical Therapy

  • The mainstay of treatment for esophageal stricture is dilation.[1]
  • Proton pump inhibitors or H2 antagonists are recommended among all patients who develop esophageal stricture due to gastroesophageal reflux disease. Studies show proton pump inhibitors are more effective than acid blocking agent[1][2]
  • Life Style Modification
    • For esophageal stricture due to gastroesophageal reflux disease, patients are advised to avoid: [3][4]
      • Spicy foods,
      • Tobacco,
      • Alchohol
      • Peppermint
      • Chocolate
      • Food before bedtime 
  • Pneumatic or bougie dilation is the standard treatment[5]
  • Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
  • Brachytherapy is recommended among patients with malignant esophageal stricture with a life expectancy more than three months.[6]
  • Self dilation at home  with bougie dilators [7]
  • Antibiotics for infectious causes of esophageal stricture
  • Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
  • Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
  • Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
  • Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
  • Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
  • Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

Esophageal stricture

  • Adult[8]
    • Preferred regimen : Omeprazole (Prilosec) :20 mg PO daily following esophageal dilatation.
      • Omeprazole (Prilosec): 40 mg twice daily for patients who do not respond to the standard dose
    • Alternative regimen : Ranitidine 150 mg twice daily
  • Pediatric[9]
    • Omeprazole 2 mg/kg PO per day

Neonates (Off-label)

Refractory duodenal ulcer or reflux esophagitis: 0.5-1.5 mg/kg PO qDay for up to 8 weeks

References

  1. 1.0 1.1 Smith PM, Kerr GD, Cockel R, Ross BA, Bate CM, Brown P, Dronfield MW, Green JR, Hislop WS, Theodossi A (1994). "A comparison of omeprazole and ranitidine in the prevention of recurrence of benign esophageal stricture. Restore Investigator Group". Gastroenterology. 107 (5): 1312–8. PMID 7926495.
  2. Marks RD, Richter JE, Rizzo J, Koehler RE, Spenney JG, Mills TP, Champion G (1994). "Omeprazole versus H2-receptor antagonists in treating patients with peptic stricture and esophagitis". Gastroenterology. 106 (4): 907–15. PMID 7848395.
  3. Richter, Joel (2009). "Advances in GERD Current Developments in the Management of Acid-Related GI Disorders". Gastroenterol Hepatol (N Y). 5: 613–615.
  4. Kaltenbach T, Crockett S, Gerson LB (2006). "Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach". Arch. Intern. Med. 166 (9): 965–71. doi:10.1001/archinte.166.9.965. PMID 16682569.
  5. Repici A, Small AJ, Mendelson A, Jovani M, Correale L, Hassan C, Ridola L, Anderloni A, Ferrara EC, Kochman ML (2016). "Natural history and management of refractory benign esophageal strictures". Gastrointest. Endosc. 84 (2): 222–8. doi:10.1016/j.gie.2016.01.053. PMID 26828759.
  6. Siersema PD (2008). "Treatment options for esophageal strictures". Nat Clin Pract Gastroenterol Hepatol. 5 (3): 142–52. doi:10.1038/ncpgasthep1053. PMID 18250638.
  7. Dzeletovic I, Fleischer DE, Crowell MD, Pannala R, Harris LA, Ramirez FC, Burdick GE, Rentz LA, Spratley RV, Helling SD, Alexander JA (2013). "Self-dilation as a treatment for resistant, benign esophageal strictures". Dig. Dis. Sci. 58 (11): 3218–23. doi:10.1007/s10620-013-2822-7. PMID 23925823.
  8. Smith PM, Kerr GD, Cockel R, Ross BA, Bate CM, Brown P, Dronfield MW, Green JR, Hislop WS, Theodossi A (1994). "A comparison of omeprazole and ranitidine in the prevention of recurrence of benign esophageal stricture. Restore Investigator Group". Gastroenterology. 107 (5): 1312–8. PMID 7926495.
  9. Hagander, Lars; Muszynska, Carolina; Arnbjornsson, Einar; Sandgren, Katarina (2012). "Prophylactic Treatment with Proton Pump Inhibitors in Children Operated on for Oesophageal Atresia". European Journal of Pediatric Surgery. 22 (02): 139–142. doi:10.1055/s-0032-1308698. ISSN 0939-7248.

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