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What is an esophageal stricture?

An esophageal stricture is a narrowing of the esophagus, the tube that connects the mouth to the stomach. Your child may develop a stricture if they have gastroesophageal reflux or eosinophilic esophagitis, if they have had surgery on their esophagus, or if their esophagus is damaged from a caustic injury or other trauma. Some esophageal strictures are present at birth. These are called congenital esophageal strictures. An esophageal stricture can make it difficult for your child to swallow, a problem called dysphagia.

Benjamin, shown with a grilled cheese and French fries, can now eat solid foods after his surgery.

From PediaSure to pizza: A journey with esophageal stricture

After surgery, 9-year-old Benjamin can eat solid foods for the first time.

Esophageal Strictures | Symptoms & Causes

What are the signs and symptoms of esophageal strictures?

The main symptom of an esophageal stricture is difficulty swallowing. Strictures can lead to an inability to tolerate the body's own secretions, as well as feeding refusal, coughing, and retching. Strictures can also cause pain when swallowing, regurgitation (spitting up food or liquids), and weight loss. If the stricture is the result of reflux, your child may also have signs of that, such as heartburn, chest pain, or a sore throat.

What causes esophageal strictures?

Although some children can be born with congenital esophageal strictures, they are often the result of damage to the esophagus, such as that caused by:

  • Prior surgery on the esophagus
  • Caustic injuries to the esophagus, which can occur if your child ingests caustic substances such as lye, batteries, or household cleaners
  • Eosinophilic esophagitis, an inflammatory condition that can trigger symptoms similar to GERD
  • Chronic gastroesophageal reflux disease (GERD), which occurs when stomach acid backs up into your child's esophagus. Over time, this acid can damage the lining of the esophagus and lead to the development of scar tissue

Esophageal Strictures | Diagnosis & Treatments

How are esophageal strictures diagnosed?

Clinicians diagnose esophageal strictures by asking you or your child about their symptoms and taking a complete medical history. They may also recommend specific tests to check for narrowing of the esophagus, such as:

  • Esophagram (also called a barium swallow), in which your child drinks a special contrast liquid that shows up on X-ray and allows the radiologist to see parts of the body clearly
  • Endoscopy, in which a thin, lighted tube with a camera is placed through your child's mouth into the esophagus to view the inside of the esophagus

How are esophageal strictures treated?

The first-line treatment for esophageal strictures is typically dilation. In this procedure, your child's physician will guide an endoscope — a long, thin, flexible tube equipped with lights and a tiny camera — into your child's mouth and esophagus. The doctor will then guide a tiny balloon through the endoscope and into the stricture, inflating it just enough to stretch the scar tissue causing the stricture in the esophagus. Medication can also be injected into the scar tissue within the esophagus, using a small needle advanced through the endoscope. This can help decrease the formation of scar tissue. These procedures are performed while your child is under anesthesia. Their doctor will also use X-ray guidance to help them better visualize the stricture, position dilation devices, and better assess any complications.

The clinicians in the Esophageal and Airway Treatment Center at Boston Children's Hospital also offer a variety of advanced esophageal procedures to treat esophageal strictures, including stenting, endoscopic incisional therapy, and endoscopic vacuum-assisted closure (EVAC). Few other pediatric centers offer these advanced techniques.

When endoscopic procedures are not effective, your child's doctor may recommend surgery.

Esophageal Strictures | Programs & Services