Esophageal stricture natural history, complications and prognosis: Difference between revisions

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{{Esophageal stricture}}
{{Esophageal stricture}}


{{CMG}}; {{AE}}  
{{CMG}}; {{AE}} {{MA}}


==Overview==
==Overview==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
If left untreated, patients with esophageal stricture  may progress to develop [[pulmonary aspiration]], [[weight loss]], and [[dehydration]]. Common [[complication]]<nowiki/>s of esophageal stricture include [[perforation]], [[bleeding]], [[pneumonia]], [[bacteremia]]. [[Prognosis]] is generally good but recurrence of symptoms after [[dilation]] are prevalent and usually recurrent [[dilation]] is necessary.
 
OR
 
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
 
OR
 
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==


===Natural History===
===Natural History===
 
* The natural history of [[benign]] esophageal stricture<nowiki/>s starts with gradual [[dysphagia]] to [[solid]] food and [[heartburn]].<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>  
'''Natural history and management of refractory benign esophageal strictures.'''
* In some cases of esophageal stricture, symptoms of [[heartburn]] disappear when [[fibrosis]] is established.<ref name=":0">{{Cite journal|last=Lundell, M.D., Ph.D.|first=Lars|date=|title=Reflux esophagitis and peptic strictures|url=http://www.nature.com/gimo/contents/pt1/full/gimo43.html|journal=GI Motility online|volume=|pages=|via=}}</ref>
 
*If left untreated, patients with esophageal stricture may progress to develop:<ref name="pmid28783923">{{cite journal |vauthors=Hwang JJ |title=Safe and Proper Management of Esophageal Stricture Using Endoscopic Esophageal Dilation |journal=Clin Endosc |volume=50 |issue=4 |pages=309–310 |year=2017 |pmid=28783923 |pmc=5565041 |doi=10.5946/ce.2017.100 |url=}}</ref>
'''Natural history and management of refractory benign esophageal strictures'''
**[[Pulmonary aspiration]]
 
**[[Weight loss]]  
'''Peptic esophageal stricture: is surgery still necessary?'''
**[[Dehydration]]  
 
'''Predictor of massive bleeding following stent placement for malignant oesophageal stricture/fistulae: a multicentre study'''
 
'''Complications of esophageal stricture dilation'''
 
'''Over time, the damage caused by stomach acid can scar the lining of the esophagus.When this scar tissue builds up, it makes the esophagus narrow. Called strictures, these narrow spots make it hard to swallow food and drinks, which can lead to weight lossand dehydration. medscape'''
 
'''Refractory Esophageal Strictures: What To Do When Dilation Fails'''
 
Patterns of acid reflux in complicated oesophagitis.https://en.wikibooks.org/wiki/Radiation_Oncology/Toxicity/Esophagus
 
https://en.wikibooks.org/wiki/Radiation_Oncology/Toxicity/Esophagus
* The natural history of benign esophageal strictures starts with gradual dysphagia to solid food and heartburn. <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> Sometimes there is no history of heartburn and reflux symtoms before diagnosis of esophageal stricture because of progression of fibrosis.
* e typical presentation of esophageal stricture includes the insidious and sometimes sudden occurrence of dysphagia to solid food with antecedent pyrosis. However, in up to 25% of cases there is no prior history of heartburn and other acid-related symptoms. In fact, some patients present a history in which reflux-related symptoms might even resolve over time secondary to progression of fibrosis and esophageal narrowing, only to return after therapeutic dilation.
*If left untreated, patients with esophageal stricture may progress to develop pulmonary  aspiration, weight loss, and dehydration.
*RBES resolution was achieved in only 22 of 70 (31.4%) patients. Two deaths (3%) were related to RBES. The success rate was lower in those who also were treated with endoprosthetics (odds ratio [OR] 3.7; 95% confidence interval [CI], 1.01-18.0). The mean dysphagia-free period was 3.3 months (95% CI, 2.4-4.1) for patients treated with dilation and 2.4 months (95% CI, 1.2-3.6) for those treated with stents (P = .062). Over time, the total dysphagia-free period increased at a rate of 4.1 days (95% CI, 1.7-6.4) per dilation. There was no difference in the rate of change across groups defined by sex (P = .976), age (P = .633), or endoscopic treatment (P = .267).


===Complications===
===Complications===
*Common complications of esophageal stricture include:<ref>{{cite journal |vauthors=van Boeckel PG, Siersema PD |title=Refractory esophageal strictures: what to do when dilation fails |journal=Curr Treat Options Gastroenterol |volume=13 |issue=1 |pages=47–58 |year=2015 |pmid=25647687 |pmc=4328110 |doi=10.1007/s11938-014-0043-6 |url=}}</ref>
*Common complications of esophageal stricture include:<ref name=":1">{{cite journal |vauthors=van Boeckel PG, Siersema PD |title=Refractory esophageal strictures: what to do when dilation fails |journal=Curr Treat Options Gastroenterol |volume=13 |issue=1 |pages=47–58 |year=2015 |pmid=25647687 |pmc=4328110 |doi=10.1007/s11938-014-0043-6 |url=}}</ref><ref name="pmid26944699">{{cite journal |vauthors=Liu SY, Xiao P, Li TX, Cao HC, Mao AW, Jiang HS, Cao GS, Liu J, Wang YD, Zhang XS |title=Predictor of massive bleeding following stent placement for malignant oesophageal stricture/fistulae: a multicentre study |journal=Clin Radiol |volume=71 |issue=5 |pages=471–5 |year=2016 |pmid=26944699 |doi=10.1016/j.crad.2016.02.001 |url=}}</ref>
**Perforation
**[[Perforation]]
**Bleeding<ref name="pmid26944699">{{cite journal |vauthors=Liu SY, Xiao P, Li TX, Cao HC, Mao AW, Jiang HS, Cao GS, Liu J, Wang YD, Zhang XS |title=Predictor of massive bleeding following stent placement for malignant oesophageal stricture/fistulae: a multicentre study |journal=Clin Radiol |volume=71 |issue=5 |pages=471–5 |year=2016 |pmid=26944699 |doi=10.1016/j.crad.2016.02.001 |url=}}</ref>  
**[[Bleeding]]
**Bacteremia
**[[Pneumonia]]
**[[Bacteremia]]


===Prognosis===
===Prognosis===
*Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
*[[Prognosis]] is generally good and depends on the cause of esophageal stricture. More than 80-90% of esophageal stricture<nowiki/>s respond well to [[Endoscopy|endoscopic]] [[dilation]] but one third of patients have recurrent symptoms after one year.<ref name=":1" /><ref name="pmid25647687">{{cite journal |vauthors=van Boeckel PG, Siersema PD |title=Refractory esophageal strictures: what to do when dilation fails |journal=Curr Treat Options Gastroenterol |volume=13 |issue=1 |pages=47–58 |year=2015 |pmid=25647687 |pmc=4328110 |doi=10.1007/s11938-014-0043-6 |url=}}</ref>
*Depending on the extent of the [tumor/disease progression/etc.] at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor/good/excellent.
*[[Weight loss]] is associated with poor [[prognosis]] among patients with esophageal stricture.<ref name="pmid24876933">{{cite journal |vauthors=Berry MF |title=Esophageal cancer: staging system and guidelines for staging and treatment |journal=J Thorac Dis |volume=6 Suppl 3 |issue= |pages=S289–97 |year=2014 |pmid=24876933 |pmc=4037413 |doi=10.3978/j.issn.2072-1439.2014.03.11 |url=}}</ref>
*The presence of weight loss is associated with a particularly poor prognosis among patients with esophageal stricture.
*Progressive [[gastroesophageal reflux]] may lead to extended esophageal stricture which prevent [[gastric acid]] to flow back in the [[esophagus]]. Loss of previous [[heartburn]] is related to more esophageal stricture.<ref name=":0" />
*Loss of previous heartburn is associated with more esophageal stricture
*[Subtype of disease/malignancy] is associated with the most favorable prognosis.
*The prognosis varies with the [characteristic] of tumor; [subtype of disease/malignancy] have the most favorable prognosis.


==References==
==References==
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[[Category:Gastroenterology]]
[[Category:Medicine]]
[[Category:Up-To-Date]]

Latest revision as of 21:41, 29 July 2020

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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

If left untreated, patients with esophageal stricture may progress to develop pulmonary aspiration, weight loss, and dehydration. Common complications of esophageal stricture include perforation, bleeding, pneumonia, bacteremia. Prognosis is generally good but recurrence of symptoms after dilation are prevalent and usually recurrent dilation is necessary.

Natural History, Complications, and Prognosis

Natural History

Complications

Prognosis

References

  1. 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.
  2. 2.0 2.1 Lundell, M.D., Ph.D., Lars. "Reflux esophagitis and peptic strictures". GI Motility online.
  3. Hwang JJ (2017). "Safe and Proper Management of Esophageal Stricture Using Endoscopic Esophageal Dilation". Clin Endosc. 50 (4): 309–310. doi:10.5946/ce.2017.100. PMC 5565041. PMID 28783923.
  4. 4.0 4.1 van Boeckel PG, Siersema PD (2015). "Refractory esophageal strictures: what to do when dilation fails". Curr Treat Options Gastroenterol. 13 (1): 47–58. doi:10.1007/s11938-014-0043-6. PMC 4328110. PMID 25647687.
  5. Liu SY, Xiao P, Li TX, Cao HC, Mao AW, Jiang HS, Cao GS, Liu J, Wang YD, Zhang XS (2016). "Predictor of massive bleeding following stent placement for malignant oesophageal stricture/fistulae: a multicentre study". Clin Radiol. 71 (5): 471–5. doi:10.1016/j.crad.2016.02.001. PMID 26944699.
  6. van Boeckel PG, Siersema PD (2015). "Refractory esophageal strictures: what to do when dilation fails". Curr Treat Options Gastroenterol. 13 (1): 47–58. doi:10.1007/s11938-014-0043-6. PMC 4328110. PMID 25647687.
  7. Berry MF (2014). "Esophageal cancer: staging system and guidelines for staging and treatment". J Thorac Dis. 6 Suppl 3: S289–97. doi:10.3978/j.issn.2072-1439.2014.03.11. PMC 4037413. PMID 24876933.

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