Esophageal stricture
Alerts and Notices
Synopsis
Caustic substances include ammonium hydroxide, sodium and potassium hydroxide (lye), sodium hypochlorite (bleach), acetic acid, hydrochloric acid, oxalic acid, phosphoric acid, selenious acid, sulfuric acid, nitric acid, cationic detergents, hydrofluoric acid, hydrogen peroxide, phenol, and zinc chloride. Frequently, ingestion of these substances by adults and adolescents may be deliberate. Caustic-induced injuries in children in developed countries have increased due to ingestion of the liquid inside laundry- and dish-detergent capsules ("pods").
Esophageal strictures most commonly present as dysphagia, more typically to solids but sometimes to liquids, which can progressively worsen. Additional symptoms include heartburn, odynophagia, acute or chronic food impactions, chest pain (referred), and weight loss if oral intake is compromised.
The etiology of esophageal strictures can be organized into benign causes (peptic strictures [the most common], esophageal rings, esophageal webs, radiation-related injury, strictures at anastomoses, or secondary to caustic injury) or malignant causes (esophageal cancer being the most common). It is uncommon for esophageal strictures to be asymptomatic, but, depending on the underlying etiology, they can be rapidly progressive or have an insidious onset.
Codes
ICD10CM:K22.2 – Esophageal obstruction
SNOMEDCT:
63305008 – Stricture of esophagus
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Peptic ulcer disease
- Mallory-Weiss syndrome
- Eosinophilic esophagitis
- Gastroesophageal reflux disease
- Esophageal motility disorders (achalasia, esophageal spasm)
- Esophageal foreign body
- Esophageal food impaction
- Esophageal cancer
- Caustic ingestion
- Pill esophagitis
- Zenker diverticulum
- Myocardial infarction
- Pulmonary embolism
- Mediastinal mass externally compressing the esophagus
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:09/02/2020
Last Updated:09/13/2020
Last Updated:09/13/2020