Practice patterns in the management of patients with esophageal strictures and rings.

BACKGROUND: Only few data exist on the epidemiology and management of esophageal strictures and rings.

OBJECTIVE: To study the epidemiology and management of esophageal strictures and rings.

DESIGN: Case-control study.

SETTING: Endoscopic data repository of U.S. gastroenterology practices from 1998 to 2003 (Clinical Outcomes Research Initiative).

PATIENTS: Case subjects included 7287 patients with strictures and 4993 patients with rings. The control group consisted of 124,120 patients without endoscopic evidence of esophageal stenosis.

INTERVENTIONS: Esophageal dilation.

MAIN OUTCOME MEASUREMENTS: Patient demographics, types and diameters of esophageal dilators, frequency of repeat dilations.

RESULTS: Strictures displayed a male predominance, and rings displayed a small female predominance. Compared with the control population, strictures and rings both occurred most frequently in elderly white patients. Dysphagia and reflux were the most common indications for dilation in both conditions. Compared with strictures, rings were treated more often with larger dilators and rubber bougies. One-year rates of repeat dilation for strictures and rings were 13% and 4%, respectively. The mean interval length between repeat dilations was 82 days for strictures and 184 days for rings.

LIMITATIONS: Only a limited amount of information about individual patients was retrievable from the electronic database.

CONCLUSIONS: The variations in the demographic characteristics and the treatment practice allude to differences in the underlying pathophysiology of these 2 benign obstructing lesions of the esophagus.