CHECK-UP:Oesophageal stricture is a narrowing of the oesophagus or gullet
I’VE BEEN having choking episodes while eating. Although embarrassing when in company, I’m reluctant to do anything about it. I have peptic ulcer disease, but am otherwise healthy. What could be causing this problem and is there any harm in not having it investigated?
You may have a condition known as oesophageal stricture. This is a narrowing of the oesophagus or gullet – the tube from the mouth to the stomach. The condition causes swallowing difficulties for sufferers. Oesophageal stricture can develop for a number of reasons including chronic reflux of acid from the stomach, a cancerous growth or as a result of long-term use of a feeding tube passed through the nose and into the stomach. It can also occur as a result of treatment of enlarged veins in the gullet, infection, or following the swallowing of corrosive substances. Symptoms may include difficulty swallowing, pain on swallowing, choking and regurgitation of food. It may lead to unintentional weight loss as a result of the person not getting enough fluids and nutrients. If food and fluids are regurgitated, there is a risk they might enter the lungs causing pneumonia (aspiration pneumonia) or choking.
I’m a bit of a coward when it comes to medical procedures. How invasive are the tests used to diagnose a stricture?
Confirming a diagnosis of an oesophageal stricture can be made in two ways. The first is by X-ray, whereby the person swallows barium which should show the presence of narrowing of the gullet. Alternatively, an examination of the gullet and stomach may be carried out using a flexible scope. Called an endoscopy, this test has the advantage that the stomach can be viewed and tissue samples taken to confirm the presence of infection or ulceration in the stomach. Endoscopic examination takes less than a half-an-hour during which you will be sedated. You will need to fast from the night before the test and will not be able to drink fluids until after the procedure is completed. If a stricture is found, then dilation (stretching) of the oesophagus is the preferred treatment. As the stricture may develop again in the future, repeated dilation may be necessary. Medication called proton pump inhibitors (acid-blocking medicines such as Losec and Protium) can help prevent the recurrence of a stricture. Surgical treatment of the condition is rarely necessary.
