Benign stenosis of the proximal oesophagus, most often a complication of gastro-oesophageal reflux

Background and objective: Benign stenoses can occur anywhere in the oesopha gus, but are most common in its distal part as a result of gastro-oesophage al reflux (GOR). It was the aim of this study to evaluate retrospectively t he causes and incidence of benign stenosis of the proximal oesophagus (SPR) as well as its endoscopic and drug treatment. Patients and methods: Between December 1989 and December 1997 a total of 17 413 patients were referred to the authors' hospital for oesophago-gastroduo denoscopy, 1024 of them (6%) for clarification of heartburn, regurgitation and/or dysphagia. 53 of these patients (5%) were found to have benign steno sis of the oesophagus requiring bougie dilatation, located in the lower thi rd in 29 (55%), in the middle third in six (11%) and in the upper third in 18 (34%) patients. Causes of stenosis in the upper third were peptic strict ure in nine (50%), heterotopic gastric mucosa in three (17%), caustic corro sion in three (17%), post-radiation in two (11%) and the result of web form ation in one (6%). Endoscopic bougie dilatation was performed in all these patients, those with GOR additionally receiving 40 mg omeprazole daily. Results: In those patients with nonpeptic benign stenosis/stricture lasting improvement of symptoms was achieved with one to three dilatations. But th ose with GOR needed a mean of 13 dilatations during a follow-up period aver aging 61 months. Barrett's oesophagus (replacement of squamous by columnar epithelium) was found in five patients. No case of dysplasia was discovered . Laparoscopic fundoplication was performed in one woman in whom bougie dil atation had failed. Remission was maintained, as needed, by bougie and omep razole in eight patients. Conclusion: In benign stenosis of the upper oesophagus endoscopic dilatatio n is the treatment of choice. In cases of peptic aetiology the administrati on of proton pump inhibitors is the optimal adjuvant method.