Esophageal stricture medical therapy: Difference between revisions

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Main stay of treatment of esophageal stricture is dilatation.
Supportive medical therapy for esophageal stricture secondary to Gastroesophageal reflux disease includes proton pump inhibitors.
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.
__NOTOC__
__NOTOC__
{{Esophageal stricture}}
{{Esophageal stricture}}
{{CMG}}; {{AE}}  
{{CMG}}; {{AE}} {{MA}}


==Overview==
==Overview==
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
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
The mainstay of treatment for [disease name] is [therapy].
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
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 lifestyle modification for [[gastroesophageal reflux disease]].
 
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==
==Medical Therapy==
* 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>
* 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>


* 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<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>


* '''Life Style Modification''' 
=== Lifestyle modification ===
** 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>  
: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 foods,
:* [[Spicy food|Spicy food<nowiki/>s]]  
*** Tobacco,
:* [[Tobacco]]  
*** Alchohol
:* [[Alcohol]]
*** Peppermint
:* [[Peppermint]]
*** Chocolate 
:* [[Chocolate]]  
*** Food before bedtime  
:* [[Food]] before bedtime 
 
* Pneumatic or bougie dilation is the standard treatment<ref name="pmid26828759">{{cite journal |vauthors=Repici A, Small AJ, Mendelson A, Jovani M, Correale L, Hassan C, Ridola L, Anderloni A, Ferrara EC, Kochman ML |title=Natural history and management of refractory benign esophageal strictures |journal=Gastrointest. Endosc. |volume=84 |issue=2 |pages=222–8 |year=2016 |pmid=26828759 |doi=10.1016/j.gie.2016.01.053 |url=}}</ref>
* 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.<ref name="pmid18250638">{{cite journal |vauthors=Siersema PD |title=Treatment options for esophageal strictures |journal=Nat Clin Pract Gastroenterol Hepatol |volume=5 |issue=3 |pages=142–52 |year=2008 |pmid=18250638 |doi=10.1038/ncpgasthep1053 |url=}}</ref>
*Self dilation 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>
 
*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===
===Esophageal stricture===
* '''Adult<ref name="pmid79264952">{{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>'''
* '''Adult<ref name="pmid79264952">{{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>'''
** Preferred regimen : Omeprazole (Prilosec) :20 mg PO daily following esophageal dilatation.
** Preferred regimen : [[Omeprazole]] (Prilosec) :20 mg [[Per os|P.O.]] daily following [[esophageal]] [[Dilation|dilatation]]  
*** Omeprazole (Prilosec): 40 mg twice daily for patients who do not respond to the standard dose
*** [[Omeprazole]] (Prilosec): 40 mg twice daily for nonresponders to the [[standard]] [[dose]]
** Alternative regimen : Ranitidine 150 mg twice daily
** Alternative regimen : [[Ranitidine]] 150 mg twice daily
 
* '''Pediatric'''
** Omeprazole 2 mg/kg  PO per day
 
***** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
****** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
****** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
****** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
****** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
****** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
*****1.1.2.2 (Specific population e.g. '<nowiki/>'''''children < 8 years of age'''''')
****** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
****** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
****** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
****** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 1.2 '''Specific Organ system involved 2'''
*** 1.2.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 1.2.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
 
* 2 '''Stage 2 - Name of stage'''
** 2.1 '''Specific Organ system involved 1 '''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.1.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2 '''Other Organ system involved 2'''
**: '''Note (1):'''
**: '''Note (2):'''
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
*


=== GERD ===
* '''Pediatric<ref name="HaganderMuszynska2012">{{cite journal|last1=Hagander|first1=Lars|last2=Muszynska|first2=Carolina|last3=Arnbjornsson|first3=Einar|last4=Sandgren|first4=Katarina|title=Prophylactic Treatment with Proton Pump Inhibitors in Children Operated on for Oesophageal Atresia|journal=European Journal of Pediatric Surgery|volume=22|issue=02|year=2012|pages=139–142|issn=0939-7248|doi=10.1055/s-0032-1308698}}</ref>'''
Indicated for treatment of GERD
** [[Omeprazole]] 2 mg/kg [[Per os|P.O.]] per day
 
<1 year: Safety and efficacy not established
 
5-10 kg: 5 mg PO qDay
 
10-20 kg: 10 mg PO qDay
 
>20 kg: 20 mg PO qDay
 
=== Erosive Esophagitis ===
Indicated for treatment and to maintain healing of erosive esophagitis caused by acid-mediated GERD
 
Treatment
* <1 month: Safety and efficacy not established
* Aged 1 month to <1 year
** 3 to <5 kg: 2.5 mg qDay
** 5 to <10 kg: 5 mg qDay
** ≥10 kg: 10 mg qDay
** May treat for up to 6 weeks
* Aged 1-16 years
** 5 to <10 kg: 5 mg PO qDay
** 10 to <20 kg: 10 mg PO qDay
** ≥20 kg: 20 mg PO qDay
** May treat for 4-8 weeks
Maintenance of healing
* <1 year: Safety and efficacy not established
* ≥1 year: Controlled trials for maintenance do not extend beyond 12 months
 
=== Neonates (Off-label) ===
Refractory duodenal ulcer or reflux esophagitis: 0.5-1.5 mg/kg PO qDay for up to 8 weeks


==References==
==References==
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[[Category: (name of the system)]]
 
[[Category:Gastroenterology]]
[[Category:Medicine]]
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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 lifestyle 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]

Lifestyle modification

For esophageal stricture due to gastroesophageal reflux disease, patients are advised to avoid:[4][5]

Esophageal stricture

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. ↑ 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.
  3. ↑ 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.
  4. ↑ Richter, Joel (2009). "Advances in GERD Current Developments in the Management of Acid-Related GI Disorders". Gastroenterol Hepatol (N Y). 5: 613–615.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 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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