BOF: 2.24
A 65-year-old male presents with intermittent dysphagia.
There is no loss of weight. He is referred for endoscopy and the
endoscopist reports a tight peptic stricture, which is dilated successfully.
Biopsies from the area do not reveal a malignancy.
In the long term management of this patient the most
important step would be:
a)
Long term acid suppression with a proton pump inhibitor
b)
Regular endoscopic surveillance
c)
Regular dilatation to prevent recurrence
d)
Insertion of an oesophageal stent
e)
Formal surgical correction of the stricture
Answer:
a)
The patient has a benign oesophageal stricture. This is a
consequence of reflux oesophagitis and the most important step in management
is to prevent reflux by using long-term acid suppression.
Endoscopic surveillance is of no benefit.
Repeat dilation would be required if the patient were to
become symptomatic but regular dilatation is not undertaken.
Stents are used only for narrowing of the oesophagus
caused by cancer.
Surgery is rarely required for benign oesophageal
stricture.
