Esophageal stricture: incidence, treatment patterns, and recurrence rate.
OBJECTIVE
We aimed to determine the incidence, natural history, and recurrence rate of esophageal stricture diagnosed in primary care.


METHODS
From the U.K. General Practice Research Database, we identified patients with a stricture diagnosis recorded between 1994 and 2000. Diagnoses were confirmed by general practitioner-completed questionnaires. Patients with stricture were compared to an age- and sex-matched sample of controls from the original source population. We estimated the incidence of stricture, potential risk factors, and comorbidities, and relative risk (RR) for subsequent stricture recurrence and mortality.


RESULTS
The incidence of esophageal stricture was 1.1 per 10,000 person-years and increased markedly with age. Incidence of stricture decreased from 1994 to 2000, concomitant with a substantial increase in proton pump inhibitor (PPI) use. The majority of stricture cases (68%) were peptic. Prior dysphagia, gastroesophageal reflux disease (GERD), hiatus hernia, peptic ulcer disease, and heavy alcohol use were associated with an increased risk of stricture. The rate of stricture recurrence was 11.1 per 100 person-years. Risk of recurrence associated with long-term PPI use adjusting for other factors was 0.6 (95% CI 0.3-1.1). Mortality in patients with peptic stricture was similar to that in the control population.


CONCLUSIONS
Esophageal stricture is a rare event, and most cases in primary care are peptic strictures. Prior GERD, hiatus hernia, and peptic ulcer are associated with an increased risk of peptic stricture. Incidence of stricture decreased from 1994 to 2000.
Ruigómez
Ana
A
Centro Español de Investigación Farmacoepidemiológica, Madrid, Spain.
García Rodríguez
Luis Alberto
LA
Wallander
Mari-Ann
MA
Johansson
Saga
S
Eklund
Stefan
S
D000328:Adult; D000368:Aged; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D015331:Cohort Studies; D004940:Esophageal Stenosis / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D054328:Proton Pump Inhibitors; D012008:Recurrence; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology
D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors