Esophageal stricture medical therapy

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.

Esophageal stricture Microchapters
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Overview
Historical Perspective
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Differentiating Esophageal stricture from other Diseases
Epidemiology and Demographics
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Diagnostic study of choice
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

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

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.

• 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

• Life Style Modification
  • For esophageal stricture due to gastroesophageal reflux disease, patients are advised to avoid:
    • Spicy foods,
    • Tobacco,
    • Alchohol
    • Peppermint
    • Chocolate
    • Food before bedtime 

• Pneumatic or bougie dilation is the standard treatment
• 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.
• Self dilation at home  with bougie dilators 

• 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
  • 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
  • Omeprazole 2 mg/kg PO per day

GERD

Indicated for treatment of GERD

<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