An abnormal narrowing of the esophageal
Esophageal stricture is most often caused by fibrosis secondary to severe ulcerative inflammatory changes in the esophageal mucosa, submucosa, and muscularis. Gastroesophageal reflux, injury from swallowed chemicals, and esophageal foreign body are the most important causes of esophageal inflammation (see Esophagitis). Esophageal stricture can also be caused by esophageal surgery and by intraluminal or extraluminal mass lesions (e.g., neoplasia or abscess). Spirocerca lupi granuloma is occasionally associated with esophageal stricture.
Gastronintestinal--esophagus affected segmentally or diffusely
Respiratory-- aspiration pneumonia may develop secondary to regurgitation
No apparent genetic basis
Unknown but believed to be low
Spirocerca lupi granulomatous strictures are occasionally seen in the Southeastern United States. No specific geographic distribution for other causes.
Species Dogs and cats
Breed Predilections None reported
MEAN AGE AND RANGE
Any age, but neoplastic strictures tend to occur in middle-aged to old animals
PREDOMINANT SEX None
Clinical signs related to the severity and extent of esophageal stricture.
Stricture can occur in any segment or over any length of the esophagus.
Regurgitation--usually observed shortly after feeding, and affected animals may reingest the regurgitated meal. Liquid meals often tolerated better than solid meals
Good appetite initially, but eventually anorexia with progressive esophageal narrowing and inflammation
Weight loss and malnutrition as the disease progresses
Aspiration pneumonia with progressive
regurgitation and dysphagia
Physical Examination Findings
Aside from cachexia and malnutrition, the physical examination is often nonremarkable
Salivation may be observed in animals that have concurrent esophagitis.
Pulmonary wheezes and coughing may also be detected in animals with aspiration pneumonia.
Ingestion of chemical irritants
Gastroesophageal reflux of gastric and intestinal juice
Esophageal foreign body
Malignancies-- intramural and extramural
Spirocerca lupi granuloma
Anesthesia--poor patient preparation and poor patient positioning during anesthesia place some animals at risk for gastroesophageal reflux, esophagitis, and subsequent stricture formation.
Vascular ring anomaly--an important differential diagnosis in a young animal with midesophageal body stricture and proximal esophageal dilation. These animals are usually examined shortly after weaning.
Esophagitis --patient may have identical clinical signs as those of esophageal stricture. Differentiation requires barium contrast radiography or endoscopy.
Intraluminal mass--often detected by radiography, but some may require endoscopy. Leiomyoma, squamous cell carcinoma, fibrosarcoma, and osteosarcoma are the most common esophageal malignancies.
Extraluminal periesophageal mass--often detected by radiography, but may require thoracic ultrasonography. Lymphosarcoma, heart base tumor, and mediastinal abscessation are the most common causes of extraluminal esophageal compression.
Results usually normal. Animals with ulcerative esophagitis or aspiration pneumonia may have leukocytosis and neutrophilia.
OTHER LABORATORY TESTS N/A
Survey thoracic radiographs are usually normal. An intraluminal or extraluminal mass lesion may occasionally be seen. Aspiration pneumonia may also be evident in animals with dysphagia and frequent regurgitation.
Barium contrast radiography is usually diagnostic for the disorder. Segmental or diffuse narrowing is observed with liquid barium and barium meal. Some dilation proximal to the stricture may be seen.
Ultrasonography has not proved useful in diagnosing this disorder, unless an extramural compressive mass lesion is suspected.
OTHER DIAGNOSTIC PROCEDURES
Endoscopy should be performed in all patients to confirm the site and severity of stricture and to exclude the possibility of intraluminal malignancy.
GROSS AND HISTOPATHOLOGIC FINDINGS
Esophagitis in some patients
Dilation and muscular hypertrophy proximal to the stricture
INPATIENT VERSUS OUTPATIENT
Initially inpatient. Animals may be discharged from the hospital after adequate rehydration, dilation of the affected segment, and appropriate treatment for aspiration pneumonia.
Oral feedings should be withheld in animals with severe esophagitis. In such patients, a temporary gastrostomy tube may be placed at the time of esophageal dilation as a means of providing continual nutritional support. Liquid meals should be used when reinstituting oral feedings.
Animals do not recover from untreated esophageal stricture.
Benign strictures are best treated by esophageal dilation.
Animals with malignant stricture have a poor prognosis.
Discuss probability of recurrence.
Esophageal stricture is probably best managed by mechanical dilation with bougienage tube or balloon dilation catheter. Balloon dilation is probably safer and more effective than by bougienage tube. Balloon dilation applies radial forces to expand the stricture site. A greater risk of perforation is associated with the use of bougienage tubes because of shearing forces applied by the instrument. Redilation at 1-2 week intervals may be necessary with either approach until the stricture is resolved.
Surgical resection of esophageal stricture has been reported, but surgical failure and stricture recurrence are common. Jejunal and colonic interposition surgeries have been described but they are technically difficult to perform.
DRUGS AND FLUIDS
Animals with concurrent esophagitis should be given sucralfate suspension (0.5-1.0 grams PO q8h) and a gastric acid antisecretory agent (cimetidine 5-10 mg/kg PO q8h; ranitidine 0.5 mg/kg PO q12h; or omeprazole 0.7 mg/kg PO q24h).
Anti-inflammatory dosage of corticosteroids (e.g., prednisone 0.5-1.0 mg/kg PO q12h) has also been advocated to prevent fibrosis and restricture during the healing phase.
Sucralfate may inhibit the gastrointestinal absorption of other drugs (e.g., cimetidine, ranitidine, and omeprazole)
ALTERNATE DRUGS N/A
Repeat barium contrast studies or endoscopy every 2-3 weeks until clinical signs have resolved and adequate esophageal lumen has been achieved.
Prevent animals from ingesting caustic substances and foreign bodies.
Esophageal perforation is a potentially life-threatening complication of esophageal stricture dilation. This usually occurs at the time of esophageal dilation, although it have been observed several days to weeks after dilation.
EXPECTED COURSE AND PROGNOSIS
Animals with fibrosing esophageal stricture generally have a fair to guarded prognosis. Many of these strictures recur despite repeated esophageal dilation. Animals with malignant stricture have a poor prognosis.
ASSOCIATED CONDITIONS N/A
AGE RELATED FACTORS N/A
ZOONOTIC POTENTIAL None
Animals with esophageal stricture may have difficulty with pregnancy because of the anesthesia required and because malnutrition may develop.
Burk RL, Zawie DA, Garvey MS. Balloon catheter dilation of intramural esophageal strictures in the dog and cat: a description of the procedure and a report of six cases. Sem Vet Med Surg 1987;2:241-247.
Twedt DC. Diseases of the esophagus. In: Ettinger SJ, Feldman EC, eds. Textbook of veterinary internal medicine. Philadelphia: WB Saunders, 1994:1124-1142.
Author Robert J. Washabau
Consulting Editor Brent Jones
Diseases and Clinical Syndromes X