PURPOSE: There is no data concerning the effects of proton pump inhibitors (PPIs) on patients who first present with a reflux-induced esophageal stricture. We sought to determine the effect of PPIs in treating patients who already have a reflux stricture (RS) significant enough to cause food bolus impaction.
METHODS: Retrospective study from 2001–2007.
RESULTS: 64 patients presented with food bolus impaction at the GE junction. The obstruction was cleared by flexible and/or rigid esophagoscopy and dilations with or without biopsies performed as indicated. RS was the etiology in 42 (66%), neuromuscular disease or dysmotility in 2 (3%), esophageal cancer in 1 (2%), and no underlying pathology in 19 (29%). Patients with RS had two previous episodes of impaction (range 0–5, SD + 1) and two prior dilations (range 0–4, SD + 1). The duration of dilation-induced relief decreased with each subsequent dilation: first 30 (SD + 21 months), second 27 (SD + 15 months), and third 8 (SD + 6 months). Only 18 of the 42 patients (43%) with RS were still taking a PPI during follow-up after a mean of 38 months. Patients PPIs had a longer interval between dilations (25 + 9 months) compared to those who were not (20 + 12 months, p = 0.06). PPIs decreased the number of dilations needed (1 + 1 versus 2 + 1 dilations, p = 0.02). RS were also more likely to have another episode of impaction than those with no underlying pathology (relative risk 2.7, 95% C.I. 1.8–4.1, p < 0.0001). Mean follow-up was 38 months (range 2–120 months).
CONCLUSION: RS are well treated with dilation and PPIs. The addition of PPIs appears to decrease the number of dilations that a patient will require, as well as lengthen the interval between dilations.
CLINICAL IMPLICATIONS: This is the first manuscript to address the effect of PPIs on patients who already have a RS. PPIs appear to have beneficial effects on these patients and should be used with dilation as standard therapy.
DISCLOSURE: John Carr, No Financial Disclosure Information; No Product/Research Disclosure Information