A stricture is a narrowing of a passageway in the body. Usually a stricture occurs in a tube like structures in the body such as the esophagus, the bowel, the ureter, the bile duct and urethra. Strictures can cause difficulty in passage of contents. Strictures can be caused by scarring from prior inflammation, surgery, radiation therapy and even cancer. On imaging, there will be a narrowing of the passage way with upstream dilation.
The esophagus is a tube that allows food to go from the throat to the stomach. A stricture of the esophagus can cause difficulty with swallowing and food getting stuck in the chest. The most common cause I see is from acid reflux disease. Strictures can be benign or represent a precursor to cancer or esophageal cancer. All strictures in the esophagus should undergo evaluation with endoscopy. Strictures can be treated by dilation when benign.
Strictures of the bowel can occur from inflammatory bowel disease like Crohn’s disease, cancer, from radiation therapy, from prior ischemic bowel disease amongst others. Bowel strictures are best diagnosed on barium studies, CTs or MRIs focused on bowel or endoscopy. Strictures of bowel can be symptomatic. They can cause bowel obstructions. In some cases, cancer will need to be excluded with biopsy.
The bile duct allows passage of bile from the liver to the intestine. Stricture of the bile duct can occur from benign causes like after surgery, sclerosing cholangitis, prior stone passage and pancreatitis. Cancer can also present as a stricture of the bile duct. MRCP is the best non invasive imaging test of the bile duct. ERCP is a test where a specially trained gastroenterologist diagnoses and treats conditions of the bile and pancreatic ducts by endoscopy. Strictures can be biopsied and treated with ERCP.
Other strictures can occur in the urinary tract to involve the ureter which is the tube that goes from the kidneys to the bladder. The tube that allows the bladder to empty can also undergo a structure. Injuries, infections and prior procedures are some of the more common causes. Cancer also becomes a consideration in some cases. Urology referral and specialized imaging may be required for workup.
Strictures can occur in many passage ways of the body. This is a fixed narrowing. Strictures cause symptoms because the contents that normally pass can’t get through as well. There are many causes and the imaging can give us a reason. Biopsy may be needed in some cases when cancer is suspected. Treatment may involve dilation, stent placement or even surgery.