Esophageal stenosis is a condition that is accompanied by a pathological narrowing of the lumen of the esophagus tube. Such an abnormality can be congenital or appear in more adulthood. A disease can lead to a host of complications. Moreover, problems with swallowing and the passage of food into the stomach adversely affect the patient’s well-being and the entire body. So why does this pathology arise and is it possible to prevent its development? What signs are worth paying attention to? Are there really effective treatments?
Esophageal stenosis: what is it?
As you know, the esophagus is a hollow tube that connects the pharynx and stomach. Its average length is 25 cm. Naturally, the diameter of the tube is not the same - the esophagus has three physiological constrictions, which are located in the cricoid cartilage, bifurcation of the trachea and the opening of the diaphragm.
In modern gastroenterology, a pathology called esophageal stenosis is often found. What it is? This is a pathology that is accompanied by an uncharacteristic narrowing of the esophagus tube. Since there is a close relationship between this part of the digestive tract and other organs (in particular, the trachea, aorta, pericardium, left bronchus, vagus nerve trunk , thoracic lymphatic duct, part of the pleura), a violation of its work is associated with a host of complications.
The main causes of the development of pathology
Are there any risk factors that trigger this disease? Esophageal stenosis can have various causes. If we are talking about congenital forms of the disease, then they are associated with impaired embryonic development, as a result of which there is hypertrophy of the muscular wall of the esophagus, the appearance of fibrous or cartilage rings.
As for acquired stenosis, their causes are much more diverse:
- For example, the mucous membrane can be damaged as a result of constant contact with the acidic contents of the stomach. This is observed with reflux esophagitis, peptic ulcers, chronic gastritis, a hiatus hernia , or even severe toxicosis of pregnant women, if it is accompanied by frequent vomiting.
- Worth mentioning about injuries. The most severe stenosis of the esophagus is observed with burns by chemically aggressive means, as well as as a result of damage to the wall by a foreign body. You can get injured during various diagnostic procedures, including a probe of the stomach.
- Narrowing or even complete closure of the lumen appears as a result of cancer of the esophagus or the appearance of benign neoplasms.
- Esophageal stenosis can be associated with infectious diseases, including mycoses, scarlet fever, syphilis, tuberculosis, diphtheria.
- In some cases, the narrowing of the tube is completely associated with the pathologies of the surrounding organs. For example, the esophagus may be squeezed by abnormally located vessels or enlarged lymph nodes. The causes include mediastinal tumors and aortic aneurysm.
Forms of stenosis and their features
There are many classification systems for this pathology. For example, esophageal stenosis may be congenital or acquired. By the way, in 90% of cases it is a congenital form of the disease that occurs.
Depending on the number of affected areas, single stenosis is distinguished (the lumen of the esophagus is narrowed in only one place) and multiple (there are several foci of pathological changes). The localization of the narrowing site is also taken into account, dividing the pathology into high stenosis (localized in the cervical region), medium (narrowed area is located at the level of the bifurcation of the trachea and aortic arch), low (the focus of the pathology is located in the cardiac section) and combined.
There is a separation for the causes of the disease. For example, cicatricial stenosis of the esophagus is characterized by damage to the mucous membrane, and sometimes the muscle layer of the tube. In place of damaged tissues, connective tissue gradually appears - this is how a scar forms. The cause, as a rule, is chronic gastroesophageal reflux. Sometimes narrowing is associated with the formation and growth of tumors, which can be both benign and malignant. There are also traumatic forms of the disease. In any case, the variety and characteristics of the disease can be precisely determined only after a thorough diagnosis.
Stages of the development of the disease
In modern medicine, it is customary to distinguish four degrees of esophageal stenosis:
- At the first stage, the disease is accompanied by a narrowing of the lumen to 9-11 mm in diameter. At the same time, it is quite possible to introduce a medium-sized endoscope through it.
- The second stage is said if the diameter of the esophagus at the site of stenosis is reduced to 6-8 mm. Nevertheless, through it you can still enter a fibrobronzoscope.
- In the third stage, the esophageal tube narrows and its diameter does not exceed 3-5 mm. Through this area, the doctor can only enter a special, ultra-thin fiberoscope.
- The fourth stage of the development of the disease is characterized by a strong narrowing of the lumen, its diameter is 1-2 mm. Some patients have a complete blockage of the esophagus, which is very dangerous.
Esophageal stenosis: symptoms
The sooner the disorder is diagnosed, the faster the patient will receive the necessary treatment. So what are the signs of esophageal stenosis? Symptoms largely depend on the form and stage of development of the disease.
If we are talking about congenital pathology, then the first "disturbing calls" can be noticed almost immediately. After feeding, the baby often spits up with uncovered milk. You can also notice a strong secretion of mucus from the nasal passages, as well as excessive salivation.
In the event that the child has a moderate form of congenital stenosis, the problems begin with the introduction of the first complementary foods or solid food into the diet.
Acquired pathology develops gradually. As a rule, patients have difficulty swallowing. For example, pain during the passage of food through the esophagus, as well as the appearance of pain behind the sternum, is possible. At the initial stages, dysphagia is observed with solid foods, but as the esophageal tube narrows, it becomes difficult for a person to swallow even liquid food. Sometimes the disease becomes so serious that the patient is not able to swallow water or even saliva.
If stenosis is located in the cervical region, but drunk fluid or even pieces of food can get into the trachea, which is fraught with severe cough, laryngospasm, suffocation. In the most severe cases, stenosis leads to the development of aspiration pneumonia.
Often, hard and large pieces of food begin to accumulate in the area of narrowing, which leads to frequent nausea and vomiting, the appearance of severe soreness. The dangerous consequences of stenosis include spontaneous ruptures of the esophagus wall.
Modern diagnostic methods
After talking with the patient, the doctor may express suspicion of stenosis. Of course, further research is needed in the future. First of all, it is necessary to conduct an esophagoscopy, with which you can detect a narrowing of the lumen of the esophagus and measure its diameter, as well as examine the mucous membrane. In the presence of neoplasms or ulcers, an endoscopic biopsy can be performed for malignant cells.
An equally important diagnostic method is radiography using a contrast medium (barium salts are usually used). This procedure helps to study the relief and contours of the esophagus, as well as to study its peristalsis.
What treatment methods does modern medicine offer?
The treatment regimen depends on many factors, including the form of the pathology, the stage of its development, the patient's condition, as well as the causes of stenosis. First you need to change the diet - the diet should consist of semi-liquid and liquid foods that can pass through the narrowing of the esophagus. If we are talking about severe dysphagia of the fourth degree, when the patient is not even able to take a sip of water, nutrition is carried out intravenously.
There are several methods to eliminate the narrowing. In milder cases, balloon dilatation using bougie is performed. But if stenosis does not lend itself to such expansion methods, endoscopic dissection of strictures is performed. In the event that there is compression of the esophagus (for example, narrowing it near a growing tumor), then a special stent can be inserted into the lumen, which will preserve the necessary size of the esophagus.
Sometimes it happens that the above methods do not give the desired result, stenosis continues to progress. The doctor may decide on a more radical decision - the removal of the affected part of the esophagus with its subsequent restoration.
Is treatment possible with alternative methods?
Traditional medicine is an industry that offers a huge number of alternative treatments. Is it possible to get rid of a disease such as esophageal stenosis with their help? Treatment with folk remedies in this case is unacceptable. It is possible that the doctor will recommend to adjust the diet or give some other instructions. Home therapy in this case is strictly contraindicated.
Are there effective preventative measures?
Unfortunately, truly effective preventative drugs do not exist. As for the congenital forms, it is important for the mother to monitor the state of health. If there are risk factors (infection transferred during pregnancy, etc.), the examination should be carried out in the first days after the birth of the baby in order to be able to adjust the diet and take safety measures in time.
In adulthood, the patient is advised to monitor nutrition, as well as treat diseases of the digestive tract in time, preventing their transition to a more severe or chronic form.
Prognosis for patients with esophageal stenosis
In the absence of timely treatment, esophageal stenosis can lead to a host of complications. Nevertheless, surgical intervention can eliminate the violation. Of course, in the presence of concomitant diseases, additional therapy is necessary. Nevertheless, the prognosis for the patient is quite favorable. Relapse is possible, but, according to statistics, such cases are an exception and are extremely rare.