A STUDY ON DYSPHAGIA DUE TO BENIGN OESOPHAGEAL STRICTURES
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2017, Vol 6, Issue 73
Abstract
BACKGROUND Gastroesophageal reflux disease, alkali or acid ingestion, achalasia due to unknown aetiology are considered as main causative factors in the genesis of benign oesophageal strictures. The two types of treatment modalities are used including conservative dilatation and surgical approach according to aetiology and site of involvement. Our study attempts to understand the various aetiopathogenesis and epidemiological features of this problem and their clinical presentation; so that early detection maybe planned and various treatment modalities for achalasia cardia, peptic stricture, corrosive stricture and their results are evaluated. The aim of the study is to study various1. Aetiological factors of stricture oesophagus (benign). 2. Features and clinical presentation of stricture oesophagus, so that early detection maybe planned. 3. Treatment methods of management of benign oesophageal strictures. MATERIALS AND METHODS This is a descriptive study of dysphagia due to benign oesophageal strictures. Cases presenting in the surgical outdoor with symptoms suggestive of oesophageal stricture and admitted in different surgical and gastroenterology units were included in the study. A detailed history and examination was done in these patients. Management was done by endoscopic or manual dilatation with bougies and/or surgical operation. Surgical management consisted of Heller's cardiomyotomy or oesophagoplasty. RESULTS Total number of 40 patients of dysphagia due to benign oesophageal strictures were studied out of which 16 (40%) patients were of corrosive strictures, 14 (35%) having achalasia cardia and 10 (25%) of peptic strictures. The male-to-female ratio was 1.35:1. The mean age was 42.62 years. Strictures due to corrosive were more common in younger age groups while 20170912mthe peptic stricture occurred later in life. The incidence of various symptoms were dysphagia 100%, regurgitation 45%, epigastric or substernal pain 35%, weight loss 25% and cough in 12% cases. Patients with GERD or achalasia cardia had more dysphagia to liquid/semi-solids, while patients with corrosive ingestion (alkali/acid) had more dysphagia to solids. The most common site affected was lower third of oesophagus in 55% of cases, followed by middle third (40%) and upper third (5%). In present study, out of 40 patients, 25 patients were treated conservatively in form of dilatation and operative intervention was done in 15 patients. All of the patients of stricture due to GERD were treated by conservative management. Most of the patients with corrosive ingestion/unknown aetiology were treated by conservative management. All of the patients with achalasia cardia were treated by operative management. One patient out of 25 managed with conservative treatment developed complication in the form of oesophageal perforation. Out of 15 patients that were managed by operative treatment, 5 developed pulmonary complications and 5 developed wound infections. Out of 4 patients who had undergone oesophagoplasty, 2 suffered with minor anastomotic leaks. In our study, after treatment (surgery/dilatation), 85% of patients were able to swallow most of solids and liquids, 10% of patients could swallow only solids and 5% of patients could swallow only liquids or semisolids. CONCLUSION It can be concluded that dysphagia due to benign oesophageal stricture maybe because of post-corrosive stricture, peptic stricture, achalasia cardia, etc. Conservative treatment in the form of dilatation gives excellent results in management of dysphagia. The surgery should be offered to the patients who are otherwise fit and dilatation cannot be done due to very narrow stricture. In operative patients, results of Heller's cardiomyotomy and esophagoplasties are excellent.
Authors and Affiliations
Krishna Gopal Sharma, Minaxi Sharma, Deepak Sethi, Rajveer Singh, Anjali Sethi
Keywords
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- EP ID EP265831
- DOI 10.14260/Jemds/2017/1135
- Views 96
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