ESOPHAGEAL STRICTURE ppt for nurses.pptx

esophageal stricture

1. ESOPHAGEAL STRICTURE Definition An esophageal stricture is a gradual narrowing of the esophagus, which can lead to swallowing difficulties. The strictures are caused by scar tissue that builds up in the esophagus. Incidence It affects approximately 40% of adults. Strictures occur in 7 to 23% of patients with GERD who are untreated.

2. Causes Gastroesophageal reflux (GERD) Prolonged use of a nasogastric tube Ingestion of corrosive substances Viral or bacterial infections Injuries caused by endoscopes Systemic sclerosis (scleroderma) Esophageal surgery Esophageal cancer Radiation therapy to the chest or neck Esophageal damage caused by an endoscope Esophageal varices (enlarged veins in the esophagus that can rupture and cause severe bleeding and causes scar tissue)

3. Infectious esophagitis - Candida, herpes simplex virus(HSV),cytomegalovirus(CMV), HIV Trauma to the esophagus from external forces, foreign body, surgical anastomosis/postoperative stricture congenital esophageal stenosis Crohn's disease – chronic inflammatory disease of the digestive tract.

4. Pathophysiology Etiology The lining of the esophagus is damaged Inflammation of the oesophagus (OESOPHAGITIS) Scarring develops. The lining of the esophagus becomes stiff. The scar tissue continues to build up The esophagus begins to narrow in that area. The result then is swallowing difficulties

5. Clinical manifestations Chest pain after swallowing Progressive swallowing difficulty solid foods, liquids, discomfort with swallowing A felling that food gets stuck in the esophagus Regurgitation of foods and liquids may aspirate into the lungs, causing cough, wheezing, and shortness of breath. Weight loss Upper back pain after swallowing Frequent burping or hiccups Cough, particularly at night heartburn

6. Diagnosis A barium swallow . Patient will swallow barium and x-rays can be taken to show the narrowing of the esophagus. An endoscopy exam . This narrow tube is inserted into the esophagus and it can show any narrowing of the esophagus. Esophageal pH monitoring This test measures the amount of stomach acid that enters the esophagus. A tube is inserted through the mouth into the esophagus. The tube is usually left in esophagus for at least 24 hours.

7. Medical management Diet of liquids or soft foods Dilation . Dilation of esophagus is performed by passing a dilator or air-filled balloon through a endoscope. Repeated dilation may be necessary to prevent the stricture from returning. Proton pump inhibitors, such as omeprazole , lansoprazole or rabeprazole , can keep strictures from returning.

8. MEDICATION A group of acid-blocking drugs, known as proton pump inhibitors(PPIs ), The PPIs used to control GERD include: • omeprazole • lansoprazole • pantoprazole • esomeprazole Antacids : provide short-term relief by neutralizing acids in the stomach • Sucralfate : provides a barrier that lines the esophagus and stomach to protect them from acidic stomach juices Antihistamines (such as ranitidine and famotidine ): decrease the secretion of acid

9. Surgical management Surgical treatment is rarely necessary. It is performed if a stricture can't be dilated enough to allow solid food to pass through. Surgery is also performed if repeated dilations do not keep these strictures from returning. In severe cases - esophagus may be removed and replaced with a segment of the large intestine. Small tube is placed into the stomach (gastrostomy), so that food may bypass the esophagus completely

10. Surgical management Esophageal stent placement The insertion of esophageal stents can provide relief from esophageal stricture. A stent is a thin tube made of plastic, expandable metal, or a flexible mesh material. Esophageal stents can help keep a blocked esophagus open so you can swallow food and liquids. Patient will be under general or moderate sedation for the procedure. an endoscope is used to guide the stent into place.

11. DIET & LIFESTYLE • Elevating pillow to prevent stomach acid from flowing back up into your esophagus • Eating smaller meals • Not eating for three hours before bedtime • Quitting smoking • Avoiding alcohol Avoid foods that cause acid reflux, such as: • spicy foods • fatty foods • carbonated beverages • chocolate • coffee and caffeinated products • tomato-based foods • citrus products