Esophageal stricture medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
The mainstay of treatment for | The mainstay of treatment for esophageal stricture is [[dilation]]. [[Pharmacologic]] medical therapy for esophageal stricture secondary to [[gastroesophageal reflux disease]] includes [[Proton pump inhibitor|proton pump inhibitors]] or [[Histamine-2 receptor blocker|H2 antagonist<nowiki/>s]]. Patients are advised to consider life style modification for [[gastroesophageal reflux disease]]. | ||
==Medical Therapy== | ==Medical Therapy== | ||
* The mainstay of treatment for | * The mainstay of treatment for esophageal stricture is [[dilation]].<ref name="pmid7926495">{{cite journal |vauthors=Smith PM, Kerr GD, Cockel R, Ross BA, Bate CM, Brown P, Dronfield MW, Green JR, Hislop WS, Theodossi A |title=A comparison of omeprazole and ranitidine in the prevention of recurrence of benign esophageal stricture. Restore Investigator Group |journal=Gastroenterology |volume=107 |issue=5 |pages=1312–8 |year=1994 |pmid=7926495 |doi= |url=}}</ref> Self [[dilation]] can be considered at home with bougie dilators. <ref name="pmid23925823">{{cite journal |vauthors=Dzeletovic I, Fleischer DE, Crowell MD, Pannala R, Harris LA, Ramirez FC, Burdick GE, Rentz LA, Spratley RV, Helling SD, Alexander JA |title=Self-dilation as a treatment for resistant, benign esophageal strictures |journal=Dig. Dis. Sci. |volume=58 |issue=11 |pages=3218–23 |year=2013 |pmid=23925823 |doi=10.1007/s10620-013-2822-7 |url=}}</ref> | ||
* [[Pharmacologic]] medical therapy is recommended among all patients who develop [[esophageal]] stricture due to [[gastroesophageal reflux disease]]. Studies show [[Proton pump inhibitor|proton pump inhibitors]] are more effective than acid blocking agent.<ref name="pmid7926495" /><ref name="pmid7848395">{{cite journal |vauthors=Marks RD, Richter JE, Rizzo J, Koehler RE, Spenney JG, Mills TP, Champion G |title=Omeprazole versus H2-receptor antagonists in treating patients with peptic stricture and esophagitis |journal=Gastroenterology |volume=106 |issue=4 |pages=907–15 |year=1994 |pmid=7848395 |doi= |url=}}</ref> | * [[Pharmacologic]] medical therapy is recommended among all patients who develop [[esophageal]] stricture due to [[gastroesophageal reflux disease]]. Studies show [[Proton pump inhibitor|proton pump inhibitors]] are more effective than acid blocking agent.<ref name="pmid7926495" /><ref name="pmid7848395">{{cite journal |vauthors=Marks RD, Richter JE, Rizzo J, Koehler RE, Spenney JG, Mills TP, Champion G |title=Omeprazole versus H2-receptor antagonists in treating patients with peptic stricture and esophagitis |journal=Gastroenterology |volume=106 |issue=4 |pages=907–15 |year=1994 |pmid=7848395 |doi= |url=}}</ref> | ||
=== Lifestyle modification === | === Lifestyle modification === | ||
:For | :For esophageal stricture due to [[gastroesophageal reflux disease]], patients are advised to avoid:<ref>{{Cite journal|last=Richter|first=Joel|date=2009|title=Advances in GERD Current Developments in the Management of Acid-Related GI Disorders|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886414/|journal=Gastroenterol Hepatol (N Y)|volume=5|pages=613-615|via=}}</ref><ref name="pmid16682569">{{cite journal |author=Kaltenbach T, Crockett S, Gerson LB |title=Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach |journal=Arch. Intern. Med. |volume=166 |issue=9 |pages=965–71 |year=2006 |pmid=16682569 |doi=10.1001/archinte.166.9.965}}</ref> | ||
:* [[Spicy food | :* [[Spicy food|Spicy food<nowiki/>s]] | ||
:* [[Tobacco]] | :* [[Tobacco]] | ||
:* [[Alcohol]] | :* [[Alcohol]] | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahda Alihashemi M.D. [2]
Overview
The mainstay of treatment for esophageal stricture is dilation. Pharmacologic medical therapy for esophageal stricture secondary to gastroesophageal reflux disease includes proton pump inhibitors or H2 antagonists. Patients are advised to consider life style modification for gastroesophageal reflux disease.
Medical Therapy
- The mainstay of treatment for esophageal stricture is dilation.[1] Self dilation can be considered at home with bougie dilators. [2]
- Pharmacologic medical therapy is 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][3]
Lifestyle modification
- For esophageal stricture due to gastroesophageal reflux disease, patients are advised to avoid:[4][5]
- Spicy foods
- Tobacco
- Alcohol
- Peppermint
- Chocolate
- Food before bedtime
Esophageal stricture
- Adult[6]
- Preferred regimen : Omeprazole (Prilosec) :20 mg P.O. daily following esophageal dilatation
- Omeprazole (Prilosec): 40 mg twice daily for nonresponders to the standard dose
- Alternative regimen : Ranitidine 150 mg twice daily
- Preferred regimen : Omeprazole (Prilosec) :20 mg P.O. daily following esophageal dilatation
- Pediatric[7]
- Omeprazole 2 mg/kg P.O. per day
References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Richter, Joel (2009). "Advances in GERD Current Developments in the Management of Acid-Related GI Disorders". Gastroenterol Hepatol (N Y). 5: 613–615.
- ↑ 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.
- ↑ 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.
- ↑ 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.