Health Library

Esophageal Stricture

What Causes an Esophageal Stricture?

Esophageal strictures can happen for different reasons. They can either be present at birth or develop later. In children, most strictures are acquired, meaning they develop over time. These usually fall into three main categories: inflammation, injury or trauma, and scar tissue from a previous esophageal surgery.

Inflammation

This is one of the most common causes of strictures. When the lining of the esophagus becomes irritated or inflamed, it can swell or heal with scar tissue, which narrows the esophagus.

Common causes of inflammation include:

• Gastroesophageal reflux (GERD): When stomach acid flows back into the esophagus, it can cause repeated irritation and lead to narrowing over time.
• Eosinophilic esophagitis (EoE): A chronic allergic condition where the body reacts to certain foods or allergens, causing a buildup of inflammatory cells in the esophagus.
• Infections: Serious infections, like candida (a yeast infection), herpes simplex virus (HSV) or cytomegalovirus (CMV), can cause inflammation, especially in children with weakened immune systems.
• Chronic conditions: Rare diseases, like Crohn’s disease or epidermolysis bullosa (a skin condition that also affects the esophagus), can lead to inflammation and scarring.
• Plummer-Vinson syndrome: A rare condition tied to iron-deficiency anemia that can lead to thin layers of tissue (webs) and inflammation in the esophagus.

Injury or Trauma

Sometimes, damage to the esophagus causes scarring as it heals, which can lead to a stricture.

Examples include:

• Caustic ingestion: Swallowing harmful substances like cleaning products, bleach, lye or small batteries can cause burns in the esophagus and lead to significant scarring.
• Radiation therapy: Although rare in children, radiation to the chest or neck (often for cancer treatment) can cause long-term damage and narrowing.
• Foreign body injury: Getting a piece of food, a battery or other objects stuck in the esophagus can cause inflammation or trauma that leads to stricture.

Past Surgery

Some strictures form because of how the body heals after surgery. This is especially true if a child has had procedures involving the esophagus, such as:

• Esophageal atresia repair: A surgery done when a baby is born with a disconnected or malformed esophagus. After repair, scar tissue can form where the ends were stitched together.
• Surgery for tracheoesophageal fistula (TEF): When there is an abnormal connection between the esophagus and windpipe, surgery is needed. Scar tissue from that repair may cause narrowing.
• Any other esophageal surgery carries a small risk of scar tissue developing.

What Are the Signs and Symptoms of an Esophageal Stricture?

Symptoms can vary depending on a child’s age and how tight the stricture is. Here are some things to watch for:

In babies or toddlers:

• They may drool more than expected.
• They may refuse to eat or cry during feedings.
• They may cough or vomit after meals.
• They may not gain weight or grow well.
• They may show signs of aspiration, which happens when food or drink enters the lungs and can lead to coughing or breathing problems.

It is not unusual for these symptoms to be mistaken for common feeding issues, but if they keep happening or seem painful, talk to your doctor.

In older children:

• They may have trouble swallowing (dysphagia).
• Your child may feel like food gets stuck in their throat or chest.
• Eating may be painful.
• They may gag, choke or retch while eating.

How is an Esophageal Stricture Diagnosed?

Your child’s doctor may order a few tests to determine the significance of the stricture:

• Esophagram (barium swallow): Your child drinks a special liquid that shows up on X-rays. This lets the doctor watch how liquid moves through the esophagus in real time.
• Endoscopy (EGD): A small camera is placed down the throat while your child is asleep under anesthesia. This helps doctors see the inside of the esophagus and, if needed, take a small tissue sample (biopsy).

Sometimes food is stuck in the narrowing. In that case, doctors can remove the blockage during the endoscopy. These tests help the care team decide what kind of treatment is needed.

How is an Esophageal Stricture Treated?

The most common treatment is balloon dilation, which stretches the narrowed part of the esophagus. During an endoscopy, doctors place a small balloon into the stricture and inflate it for about a minute. The balloon gently stretches the area to help food pass through more easily and is removed before the child wakes up. This procedure is often repeated several times over the course of a few weeks to stretch the area slowly over time.

If balloon dilation does not work well enough, doctors have other tools they can try. Doctors may use steroids to reduce inflammation in the esophagus and help prevent the stricture from returning between procedures. They may also use a needle knife, a small tool that carefully cuts into tight scar tissue to release tension and allow better stretching during dilation.

Mitomycin is a special medicine sometimes applied to the stricture site to slow down the growth of scar tissue and help the esophagus stay open longer between treatments. In more stubborn cases, a stent may be placed in the esophagus. A stent is a small tube that stays in place for a short period of time to physically hold the esophagus open and give it time to heal in a more open shape.

If none of these treatments work, surgery may be needed to remove the tight area and connect the healthy ends of the esophagus.

Prognosis for an Esophageal Stricture

Most children do very well with treatment. In many cases, multiple dilations are needed close together over a few weeks or months. Over time, the esophagus usually stays open longer between procedures.

Children with esophageal strictures are usually followed long term to monitor their growth, swallowing function and overall progress. This is especially important for children with more complex or severe strictures. Follow-up care is typically managed by a team of specialists, which include surgeons, gastroenterologists (stomach doctors), pulmonologists (lung doctors), an ear nose and throat doctor (ENT), a speech therapist and dietary specialists.

Parents also get support through social workers, behavioral health experts and national support groups like EA / TEF Family Support Connection and EAT Global.

If your child has a history of esophageal problems and starts having trouble swallowing, food getting stuck or painful eating, reach out to your doctor. It may be a sign that the stricture is returning, and early treatment can make a big difference.