What are oesophageal strictures?
An oesophageal stricture is an abnormal tightening or narrowing of the oesophagus, that usually develops if there is a circumferential oesophageal trauma. Clinically evident strictures usually require a semi-thickness/circumferential injury to the mucosa and submucosa usually as a result of the effects of an irritant. Oesophageal strictures can develop in dogs and cats of any breed, age, or sex.
How can I tell my pet has an oesophageal stricture?
Regurgitation is a consistent feature of all animals with oesophageal stricture. Symptoms of regurgitation may not develop for up to 1 to 5 weeks after the inciting injury. The severity of symptoms may worsen progressively as the scar develops therefore there may initially be evidence of an oesophagitis that progresses to regurgitation of soft foods before complete intolerance and regurgitation or all foods and liquids.
What is the cause of an oesophageal stricture?
Oesophageal strictures are commonly caused by a circumferential trauma to the oesophagus. Chronic/severe oesophagitis and foreign body ingestion can also progress to stricture formation.
How is an oesophageal stricture diagnosed?
Diagnostic interventions include radiography and endoscopic examination. Plain radiographs are unhelpful for diagnosis of stricture but can rule out other potential causes of regurgitation. Contrast radiographs, however, are invaluable and should always be performed if plain radiographs are unremarkable. Barium sulphate suspension is the ideal contrast material because it is very radio-opaque and easy to administer. This solution is mixed with food to determine the severity of regurgitation. Endoscopic examinations allow direct visual inspection of the severity of the stricture and allows biopsies to be taken to rule out neoplastic causes.
How is an oesophageal stricture treated?
Balloon dilation
Balloon dilation is currently the preferred strategy for oesophageal stricture management. It is performed in combination with fluoroscopy and endoscopy. It is recommended to start with a balloon 2-4mm greater than the stricture diameter and gradually increase balloon size until maximal diameter is achieved and the stricture is completely effaced. Affected patients may require separate balloon dilation procedures to achieve successful management. There is no recommended interval between dilations but in general 7 days is considered appropriate.
Refractory (unmanageable) oesophageal strictures can be considered for placement of an indwelling balloon oesophageal (BE) tube. This is placed under fluoroscopic guidance and remains in place for 6 weeks. It allows the owner to inflate the balloon twice daily at home to prevent stricture reformation.
Oesophageal stenting
Oesophageal stenting has been investigated as a possible single-stage treatment of strictures. It improves short-term dysphagia in dogs but 77.8% experience major complications after placement, hence this is not currently recommended. Surgical management of oesophageal strictures is not always recommended due to the high morbidity and mortality associated with this.
Medical management
Medications such as sucralfate, H2-antagonists and corticosteroids may be used to manage strictures. Corticosteroids are used at anti-inflammatory doses to prevent further scar formation, but the efficacy of this treatment is doubtful.
What is the prognosis for an oesophageal stricture?
The prognosis following oesophageal stricture is guarded and the success of treatment may be relative to patient size. In general, most patients will be helped by treatment but continued dietary management will be essential for the rest of the patients’ life.