Esophageal stricture medical therapy

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]

Pharmacologic medical therapy is 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.^[1]^[3]

Lifestyle modification

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

Esophageal stricture

Adult^[6]
- Preferred regimen : Omeprazole (Prilosec) :20 mg P.O. daily following esophageal dilatation
  - Omeprazole (Prilosec): 40 mg twice daily for nonresponders to the standard dose
- Alternative regimen : Ranitidine 150 mg twice daily

Pediatric^[7]
- Omeprazole 2 mg/kg P.O. per day

References

↑ ^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.
↑ 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.
↑ 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.
↑ Richter, Joel (2009). “Advances in GERD Current Developments in the Management of Acid-Related GI Disorders”. Gastroenterol Hepatol (N Y). 5: 613–615.
↑ 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.
↑ 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.
↑ 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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[pmid7926495-1] 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.

[pmid23925823-2] 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.

[pmid7848395-3] 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.

[pmid16682569-5] 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.

[pmid79264952-6] 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.

[HaganderMuszynska2012-7] 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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