Equis ISSN 2398-2977

Esophagus: stricture

Contributor(s): Graham Munroe, Prof Jonathon Naylor

Introduction

  • Narrowing of the esophageal lumen by stricture usually an annular lesion and in the proximal third of cervical esophagus.
  • Cause: congenital; a result of cicatrization of circumferential ulceration following esophageal trauma/foreign body   Esophagus: trauma  ; leakage of saliva after surgery; external compression. 
  • Signs: recurrent choke   Esophagus: impaction  ; drooling +/- coughing following ingestion of solid food; nasal regurgitation; weight loss; poor growth.
  • Diagnosis: site may be visible externally; endoscopy   Gastrointestinal endoscopy  ; fluoroscopy; radiography (positive and negative contrast   Radiography: contrast media  ).
  • Treatment: lumenal bouginage using endotracheal tube or esophageal dilator; esophageal surgery: should be referred to specialist surgeon.
  • Prognosis: good if only mucosal stricture; poor if deeper layers of esophageal wall are involved.

Pathogenesis

Etiology

  • Esophageal impaction (choke)   Esophagus: impaction  .
  • Oral administration/ingestion of corrosive substances/medicines.
  • Trauma to neck/esophagus.
  • Congenital.
  • A variety of strictures are classified as follows:
    • Grade 1: congenital web stricture (many foals have these 'normally' and they disrupt naturally as the consistency of the food increases).
    • Grade 2: stricture involving mucosa and submucosa (esophageal webs or rings).
    • Grade 3: stricture involving mucosa, submucosa and muscular layer(s) (mural strictures).
    • Grade 4: full thickness stricture - usually a result of cicatrization of circumferential ulceration following esophageal trauma/foreign body (annular stenosis).

Specific

Pathophysiology

  • Most commonly caused by esophageal impactions   Esophagus: impaction    →   pressure necrosis   →    circumferential erosion or ulceration of esophageal mucosa   →    cicatrization of esophageal wall   Esophagus: stricture 03 - pathology  .

Timecourse

  • Maximal stricture usually occurs within 30 days of injury.
  • Mucosal web strictures resolve naturally in most cases between 30-60 days.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Reichelt U, Hamann J & Lischer C (2012) Balloon dilation of oesophageal strictures in two horses. Equine Vet Educ 24 (8), 379-384  VetMedResource.
  • Tillotson K, Traub-Dargatz J L & Twedt D (2003) Balloon dilation of an esophageal stricture in a one-month-old Appaloosa colt. Equine Vet Educ 15 (2), 67-71 VetMedResource.
  • Feige K et al (2000) Esophageal obstruction in horses - a retrospective study of 34 cases. Can Vet J 41 (3), 207-210 PubMed.
  • Meyer G A et al (2000) The effect of oxytocin on contractility of the equine esophagus - a potent treatment for oesophageal obstruction. Equine Vet J 32 (2), 151-155 PubMed.
  • Knottenbelt D C et al (1992) Conservative treatment of esophageal stricture in five foals. Vet Rec 131 (2), 27-30 PubMed.
  • Craig D et al (1987) Surgical repair of an esophageal stricture in a horse. Vet Surg 16 (4), 251-254 PubMed.
  • Gideon L et al (1984) Esophageal anastomosis in two foals. JAVMA 184 (9), 1146-1148 PubMed.
  • Nixon A J et al (1983) Esophagomyotomy for relief of an intrathoracic esophageal stricture in the horse. JAVMA 183 (7), 794-796 PubMed.
  • Suann C J et al (1982) Oesophageal resection and anastomosis as a treatment for esophageal stricture in the horse. Equine Vet J 14 (2), 163-164 PubMed.
  • Fretz P B et al (1982) Repair of esophageal stricture in the horse. Mod Vet Pract 53 (6), 31-35 PubMed.

Other sources of information

  • Jones S M & Blikslager A T (2004) Esophageal Stricture. In: Equine Internal Medicine. Saunders, USA. pp 860-861.
  • Stick J A (1999) Diseases of the Esophagus. In: Equine Medicine & Surgery. Mosby, USA. pp 695-698.


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