Oesophageal stricture: symptoms, causes and treatment in the UK

The oesophagus, also called the gullet or food pipe, is the muscular tube that carries food and drink from the mouth to the stomach. University Hospitals Dorset explains that the muscles lining it normally contract in waves to move food along, and a ring of muscle at the bottom opens to let food through and closes to stop stomach contents coming back up.

An oesophageal stricture is a narrowing in the lining of this tube. Doctors describe strictures as benign (non-cancerous) or malignant (cancerous) depending on the cause. Most strictures that arise from reflux are benign, but because a narrowing can also be caused by a tumour, any new difficulty swallowing needs to be properly investigated rather than assumed to be harmless.

Related but distinct conditions include oesophageal webs and rings, which are thin folds of tissue, and achalasia, in which the lower sphincter fails to relax. Some of these are covered on their own pages.

The leaflet from University Hospitals Dorset says an oesophageal stricture may not cause any symptoms at all and may be found during other investigations. When symptoms do occur they develop gradually and usually involve difficulty swallowing. It may feel painful at times or as though something is stuck. Food may be vomited or regurgitated, and weight loss can be a common feature that can become severe and lead to malnutrition.

The NHS page on dysphagia lists signs such as coughing or choking when eating or drinking, bringing food back up sometimes through the nose, a feeling that food is stuck in the throat or chest and a gurgly, wet-sounding voice when eating or drinking. Over time it says dysphagia can cause weight loss, dehydration and repeated chest infections.

• Food sticking, especially solids such as bread or meat.

• Pain or a feeling of something stuck when swallowing.

• Bringing food or liquid back up.

• Unplanned weight loss.

• Repeated chest infections or coughing with meals.

The NHS advises asking for an urgent GP appointment or getting help from NHS 111 if you have difficulty swallowing, cough or choke while eating or drinking, or feel like something is stuck in the throat after eating. The NHS heartburn page adds that you should see a GP if you have heartburn most days or other symptoms such as food getting stuck in the throat, frequently being sick or losing weight for no reason.

The Dorset leaflet notes that in very rare cases food may become lodged above the stricture, which can need urgent treatment to remove the blockage at endoscopy. If food will not go down at all, or you cannot swallow your own saliva, treat it as an emergency and use NHS 111 or A&E rather than waiting for a routine appointment.

According to University Hospitals Dorset, oesophageal strictures are most commonly caused by scarring from the reflux of stomach acid. Over time, repeated inflammation or ulceration of the lining can lead to scar tissue that narrows the tube. The NHS describes acid reflux as heartburn, a burning feeling in the chest caused by stomach acid travelling up towards the throat, and says that if it keeps happening it may be called GORD.

The same leaflet lists other causes: webs and rings of tissue in the oesophagus, cancerous growths in or around the oesophagus, scarring after radiotherapy, narrowing at the site of a previous operation, injury from swallowing corrosive substances, some prescribed medicines such as alendronate or anti-inflammatory painkillers, and complications of conditions such as achalasia, eosinophilic oesophagitis and oesophageal varices.

A GP can refer you for tests as a hospital outpatient. University Hospitals Dorset lists a barium swallow, in which a liquid that shows up on X-ray is swallowed to show where the oesophagus is narrowed and how long the narrowing is, and a gastroscopy. Biopsies may be taken during gastroscopy and sent for analysis to help with the diagnosis.

The NHS describes a gastroscopy as a test to check inside your food pipe, stomach and the top of your intestine using a thin tube with a camera inside it. It says you will need to stop eating at least 6 hours before, may be offered throat spray or sedation, and the procedure should take 15 to 45 minutes. If you have sedation you will need someone to take you home and stay with you for 24 hours. If a cancer is suspected, the NHS says results are usually available within 2 weeks of a biopsy, while other biopsy results can take up to 2 months.

The Dorset leaflet says the main aim of treatment is to allow food and drink to be taken so that malnutrition and weight loss can be prevented or reversed and quality of life improved. Benign strictures are usually managed by dilatation, in which a balloon is inflated at the narrowing during a gastroscopy, usually under sedation.

The Hull University Teaching Hospitals leaflet describes the balloon as being inflated to a diameter chosen by the endoscopist and normally staying inflated for 60 seconds. It quotes a perforation (tear) risk of about 1 in 100 cases with dilatation, with a higher risk, up to 10 in 100, when there is complex disease or a tumour, and says bleeding is usually not serious. Both leaflets stress that complications are rare but that repeated dilatation is not unusual and strictures can come back.

Medicines also matter. Proton pump inhibitors such as omeprazole and lansoprazole may be prescribed to reduce inflammation from acid reflux, which can help reduce the likelihood of strictures recurring in some people. Strictures that do not respond to dilatation, or that are malignant, may need surgery, and stents may be used to hold a malignant stricture open. Swallowing therapy and dietary changes such as softer foods are also part of the NHS dysphagia approach.

Managing reflux is part of long-term care. The NHS suggests eating smaller, more frequent meals, avoiding food and drink that trigger symptoms, not eating within 3 or 4 hours of bedtime, not smoking and cutting down alcohol, and says raising the head of the bed by around 10 to 20cm can help. Do not stop prescribed medicines without speaking to a doctor.

Eating slowly, chewing thoroughly and choosing softer foods can reduce the chance of food catching. A speech and language therapist or dietitian can help if swallowing remains difficult, as the NHS dysphagia page notes.

Investigation and dilatation are routinely provided by NHS endoscopy services after GP referral, and the same procedures are offered in private hospitals. The treating endoscopist should explain the risks, the number of sessions likely to be needed and what follow-up is planned.