Lower esophageal strictures, benign or malignant?

In a retrospective study of 93 patients with benign peptic strictures, and 73 patients with malignancy of the lower third of the esophagus, 93% of benign strictures were associated with a hiatal hernia, and 4% without. In malignancy the majority were without hernia. The results provide a statistical basis for strong suspicion of malignancy in a lower esophageal stricture not accompanied by a hiatal hernia.