Food Bolus Impaction Secondary to Reflux Strictures: A Rural Surgical Experience

BACKGROUND: Benign esophageal strictures at the gastroesophageal (GE) junction secondary to acid reflux have an unknown altered natural history after dilation. STUDY DESIGN: We carried out a 7-year retrospective investigation from 2001 to 2007. RESULTS: Sixty-four patients presented with food bolus impaction at the GE junction. Reflux strictures were the cause in 42 (66%), neuromuscular disease or dysmotility in 2 (3%), esophageal cancer in 1 (2%), and no underlying pathology could be identified in 19 (29%). Duration of dilation-induced relief from impaction recurrence decreased with each subsequent dilation: first 30 +/- 21 months, second 27 +/- 15 months, and third 8 6 months. Patients taking proton pump inhibitors (PPIs) had a longer interval between dilations (25 +/- 9 months) compared with those who were not (20 +/- 12 months, p = 0.06). PPIs also decreased the number of subsequent dilations needed during the course of the study (1 +/- 1 versus 2 +/- 1 dilations, p = 0.02). Reflux strictures were more likely to cause another episode of impaction than no underlying pathology (relative risk, 2.7; 95% CI, 1.8-4.1; p < 0.0001). Mean followup was 38 months (range 2 to 120 months). CONCLUSIONS: Reflux strictures are well treated with dilation and PPIs. Although food bolus impaction can occur without an underlying pathology, patients with relux strictures are likely to have a recurrence and should be treated aggressively. Addition of PPIs appears to decrease the number of dilations that a patient will require and lengthen the interval between dilations. Patients requiring more than two dilations after initiation of PPI therapy are unlikely to have durable relief. (J Am Coll Surg 2008;207:745-750. (C) 2008 by the American College of Surgeons)