What drugs are used in the treatment of esophageal stricture?

Esophageal stricture is a serious sequela of many different pathological processes. Detection and treatment must be carried out promptly and actively to restore the patency of the esophageal lumen.

1. Dangers of esophageal stricture

Esophageal stricture is an abnormal narrowing of the lumen of the esophagus. The esophagus loses its ability to relax and this condition can be localized or spread over the entire length of the esophagus.

The most common cause of esophageal stricture is long-term gastroesophageal reflux disease (GERD), when stomach acid flows back from the stomach into the esophagus and causes esophagitis. Or it can be due to previous surgery, other procedures on the esophagus, radiation therapy, swallowing a corrosive substance that damages the esophagus...

Patients with esophageal stricture often have difficulty swallowing, feel food stuck or feel food slowly passing through the throat, chest, or upper abdomen.

At first, the person may have difficulty swallowing solid foods, but as the condition worsens, they may have difficulty swallowing liquids. The patient may also experience heartburn, regurgitation, pain when swallowing, hoarseness, sore throat, unexplained cough, or unintentional weight loss.

Esophageal stenosis makes it difficult to swallow, painful to swallow, hoarseness...

2. How to treat esophageal stricture?

Treatments for esophageal stricture aim to relieve symptoms, control complications, and treat underlying causes of the disorder.

Esophageal dilation is the initial treatment of choice for symptomatic benign esophageal strictures. Although there are several types of dilators, balloon dilation is commonly used and can be performed at the time of endoscopy.

Depending on the severity and complexity of the stricture, multiple dilations may be required to achieve adequate symptom relief. Caution is advised because of the risk of perforation when dilating the esophagus.

For some patients who do not achieve symptom relief despite regular dilations, corticosteroid injections after dilation to reduce recurrence of strictures or temporary esophageal stent placement may be required.

The most common cause of esophageal stricture is long-standing gastroesophageal reflux disease (GERD), when stomach acid backs up from the stomach into the esophagus and causes inflammation of the esophagus.

3. Drugs in the treatment of esophageal stricture

Once the esophagus is dilated, medications are also an important part of the treatment plan.

3.1. Proton pump inhibitors for esophageal stricture

- Effects: Proton pump inhibitors (PPIs) are considered the most effective drugs to control the effects of gastroesophageal reflux, prevent the stomach from secreting acid and can help the esophagus heal, preventing the narrowing from recurring.

PPIs tend to work best on an empty stomach, about 30 to 60 minutes before eating. If you take a PPI once a day, take it before your first meal of the day. If you take a PPI twice a day, it is best to take your dose before breakfast and dinner.

Medications include: Omeprazole, esomeprazole, lansoprazole, pantoprazole and rabeprazole.

- Side effects: Although PPIs are well tolerated and considered safe, long-term widespread use also causes some side effects such as headaches, nausea, impaired absorption of vitamin B12, calcium, iron, magnesium, hip fractures, pneumonia, dementia, and Clostridium difficile infection.

The best current strategies to minimize the potential risks of long-term PPIs are to avoid prescribing them when not indicated and to reduce doses to the minimum when indicated.

Esophageal dilation is the treatment of choice for benign esophageal strictures.

3.2. Antacids

- Effect: Antacids have a short-term pain-relieving effect by neutralizing stomach acid, reducing heartburn or indigestion.

Drugs include: Aluminum hydroxide, magnesium carbonate, magnesium trisilicate, magnesium hydroxide, calcium carbonate, sodium bicarbonate.

- Side effects: The drug can cause nausea, vomiting, constipation, kidney stones...

Note: Antacids should be taken 30 - 60 minutes after meals and before bedtime.

Antacids can also interact with certain medications, such as thyroid hormones and antiplatelet drugs. Antacids are not recommended for people with kidney disease or high blood calcium levels. People with blood disorders or who are taking anticoagulants may also need to consult their doctor before using them.

3.3. Histamine H2 receptor antagonists

- Effect: Histamine H2 receptor antagonists help reduce the amount of acid produced, including: Famotidine, cimetidine, nizatidine.

- Side effects of these drugs are often mild such as constipation, diarrhea, headache, nausea...

3.4. Drugs that stimulate intestinal motility

- Effect: Intestinal motility stimulants help control acid reflux in severe cases of gastroesophageal reflux, strengthen the lower esophageal sphincter and make food in the stomach empty faster. Drugs include: Metoclopramide, domperidone, erythromycin, cisapride...

Side effects: Each medication will have different side effects. In general, they can cause stomach pain, vomiting, diarrhea, or physical problems such as involuntary movements and muscle spasms.

3.5. Sucralfate

- Effects: Sucralfate can help reduce the symptoms of gastroesophageal reflux, but it does not cure the underlying cause of the disease.

- Side effects: The drug can cause digestive disorders, skin itching, dizziness, insomnia, headache...

It is necessary to comply with the doctor's instructions and directions for taking medication.

3.6. Alginic acid

- Effect: Alginic acid medicine (gaviscon) creates a layer of foam on the liquid in the stomach to prevent reflux.

- Side effects: Hives, itching, loss of appetite, muscle weakness, nausea, vomiting...

Note: Avoid taking them at the same time as other medications including PPIs. This is because the drug can affect the absorption of other drugs. Therefore, it should be used 30 to 60 minutes after eating or 2-4 hours apart from other medications and before going to bed.

4. Notes when treating esophageal stricture

To treat esophageal stricture safely and effectively, it is necessary to:

- Do not take medication without a doctor's prescription.

- Strictly follow your doctor's instructions and directions for taking medication. Do not increase/decrease/stop taking medication without consulting your doctor.

- If you experience any unusual symptoms while taking the medication, notify your doctor immediately for timely treatment.

- Regular health check-ups and follow-up tests.

In addition, lifestyle changes should be implemented:

- Eat smaller and more frequent meals, avoiding eating within two hours of bedtime.

- Avoid bending, lifting heavy objects, abdominal exercises, and belt exercises, all of which increase abdominal pressure and cause reflux.

- You should lose weight if you are overweight, because being overweight causes reflux.

- Avoid smoking, alcohol, caffeine, chocolate and fried or fatty foods, with mint flavor.

- Elevate the head of the bed by placing a pillow or wedge under the top of the mattress, which helps keep stomach acid from refluxing into the esophagus while you sleep.

Source: https://giadinh.suckhoedoisong.vn/nhung-thuoc-nao-dung-trong-dieu-tri-hep-thuc-quan-172241025165511397.htm