Peptic esophageal
strictures are a common sequelae of long-standing
reflux esophagitis. Factors predisposing to
stricture formation are poorly understood; however,
stricture patients are typically older, have a longer duration of reflux symptoms, have significantly lower lower esophageal sphincter pressures, and more frequently display abnormal esophageal motility than reflux patients without
strictures. A careful history should suggest the diagnosis in most cases, but should be confirmed with a
barium esophagram followed by endoscopy with biopsies to exclude
malignancy. The therapeutic armamentarium for treating peptic
strictures has greatly expanded during the past 30 yr. It now includes potent anti-secretory medications, bougienage with flexible
polyethylene dilators or balloons, and anti-reflux surgery. Aggressive medical
therapy combined with bougienage is safe and effective treatment for the majority of
stricture patients, with surgery being reserved for the subset of patients with intractable
esophagitis, irreversibly damaged esophagus, or extra-esophageal manifestations.