Peptic Esophagitis, Peptic Stricture, and Short Esophagus

Rafael S. Andrade, Michael A. Maddaus, Madhuri V. Rao

Key Points

Peptic Esophagitis

  • Peptic esophagitis occurs in 40% of patients with GERD
  • Impaired esophageal acid clearance may play a pivotal role
  • It may be associated with hiatal hernia
  • Peptic esophagitis precedes stricture and short esophagus
  • Proton pump inhibitor therapy resolves 90%
  • Continuous medical therapy required unless surgically treated

Peptic Stricture

  • It occurs in 8% to 23% of patients with untreated esophagitis
  • Peptic stricture is short (~1 cm)concentric, and immediately proximal to the squamocolumnar junction
  • Associated with short esophagus
  • Proton pump inhibitor therapy, dilation, and surgery are complimentary

Short Esophagus

  • The diagnosis can only be confirmed intraoperatively: the intra-abdominal esophagus is less than 2.5-cm long.
  • Associated with large hiatal hernia
  • True, reducible short esophagus (requiring mobilization): up to 20% of surgically treated GERD patients
  • True, non-reducible short esophagus (requiring gastroplasty): < 5% of surgically treated GERD patients
  • Large (Giant) hiatal hernia repair with gastroplasty and fundoplication has a recurrence requiring reoperation in less than 10% in select, experienced centers.

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Last updated: February 25, 2023