Treatment

Treatment of peptic oesophageal strictures includes:

• pharmacological measures: omeprazole has revolutionised treatment, stopping everything but volume reflux. It has been so effective that the rate of dilations has been reduced despite an increased endoscopy rate. The most suitable treatment in the very elderly.
  
  
• surgical resection: with colonic interposition in those whom dilatation has proved ineffective; to be avoided if at all possible - the oesophagus heals poorly because of a lack of serosa and sufficient blood supply
• fibre-optic endoscopy: see linked section

It has been suggested that the dilation of the stricture is simply reopening the 'floodgate' to acid reflux. In fact, there is no significant rise in the acidity of the oesophagus, especially if maintained on omeprazole.