Marks R D, Shukla M
Division of Gastroenterology and Hepatology, The University of Alabama at Birmingham 35294-0007, USA.
Gastroenterologist. 1996 Dec;4(4):223-37.
Peptic strictures of the esophagus are a common sequelae of long-standing reflux esophagitis. They occur in approximately 10% of patients with gastroesophageal reflux disease seeking medical evaluation. Factors predisposing to stricture formation are poorly understood; however, stricture patients are typically older, have a longer duration of reflux symptoms, and more frequently display abnormal esophageal motility than reflux patients without strictures. Diagnosis can usually be made with a careful history but should be confirmed with a barium esophagram followed by endoscopy with biopsies to exclude malignancy. Relief of dysphagia, which is the initial goal of therapy, can be readily accomplished in most patients using polyethylene or mercury-filled dilators or balloons. An equally important therapeutic objective should be the complete healing of associated esophagitis using proton pump inhibitors. Surgical treatment is reserved for the subset of patients with intractable esophagitis, irreversibly damaged esophagus, or extraesophageal manifestations.
食管消化性狭窄是长期反流性食管炎常见的后遗症。在寻求医学评估的胃食管反流病患者中，约10%会出现食管消化性狭窄。导致狭窄形成的因素尚不清楚；然而，与无狭窄的反流患者相比，狭窄患者通常年龄较大，反流症状持续时间更长，且食管动力异常更为常见。通常通过详细的病史即可做出诊断，但应通过食管钡餐造影进行确认，随后进行内镜检查及活检以排除恶性肿瘤。吞咽困难的缓解是治疗的首要目标，大多数患者使用聚乙烯或充汞扩张器或球囊即可轻松实现。同样重要的治疗目标是使用质子泵抑制剂使相关食管炎完全愈合。手术治疗仅适用于难治性食管炎、食管不可逆损伤或食管外表现的患者亚组。
