Benign esophageal strictures remain a significant management problem. Approximately 30 to 40% of patients experience symptomatic recurrence within 1 year of successful dilation.
In this study, researchers from Wisconsin, USA, examined the predictors of early recurrence of benign esophageal strictures following endoscopic dilation.
The research team assessed 87 consecutive outpatients who underwent initial dilation over a 1-year period.
|Non-peptic strictures were significant predictors for early recurrence.|
|American Journal of Gastroenterology|
They compared patients with recurrence of dysphagia, who required repeat dilation within 1 year of the initial dilation (cases), with patients who did not (controls).
The team assessed predictors of redilation using univariate and multivariate analysis.
In addition, the team performed a Kaplan-Meier analysis of significant predictors using time to first redilation.
The researchers found that 36 patients required repeat dilation within 1 year. The remaining 51 did not.
They determined that 77% of strictures were peptic, while the remainder were caused by radiation, drug-related injury, or congenital stenosis, and other causes.
The team found, by multivariate analysis, that non-peptic strictures were significant predictors for early recurrence, as was a narrower stricture diameter.
In addition, they determined that predictors for peptic strictures were the persistent heartburn after dilation, and the presence of a hiatal hernia.
They found that 84% of patients with peptic strictures were on proton pump inhibitors (PPIs) after dilation. There was no difference between the cases and controls.
Of all patients with persistent heartburn after dilation, 90% were on PPIs.
Dr Adnan Said's team concluded, "The persistence of heartburn after dilation is a strong predictor for early symptomatic recurrence of benign esophageal peptic strictures, despite a high rate of PPI use".
"This may suggest persistent acid reflux requiring optimization of acid reduction therapy".
"Alternatively, combined acid and alkaline reflux may account for progressive injury despite PPI therapy".
"Esophageal pH studies may be invaluable in making the distinction between acid and non-acidic (alkaline) reflux".
"Nonpeptic strictures are also more likely to have early recurrences and are therefore more difficult to manage".