PEPTIC STRICTURES OF THE ESOPHAGUS

Peptic esophageal strictures are a common sequelae of long-standing re flux esophagitis. Factors predisposing to stricture formation are poor ly understood; however, stricture patients are typically older, have a longer duration of reflux symptoms, have significantly lower lower es ophageal sphincter pressures, and more frequently display abnormal eso phageal motility than reflux patients without strictures. A careful hi story should suggest the diagnosis in most cases, but should be confir med with a barium esophagram followed by endoscopy with biopsies to ex clude malignancy. The therapeutic armamentarium for treating peptic st rictures has greatly expanded during the past 30 yr. It now includes p otent anti-secretory medications, bougienage with flexible polyethylen e dilators or balloons, and anti-reflux surgery. Aggressive medical th erapy combined with bougienage is safe and effective treatment for the majority of stricture patients, with surgery being reserved for the s ubset of patients with intractable esophagitis, irreversibly damaged e sophagus, or extraesophageal manifestations.