title: Risk factors associated with refractoriness to esophageal dilatation for benign dysphagia.
abstract: BACKGROUND
  Benign esophageal strictures need repeated dilatations to relieve dysphagia. Literature is scarce on the risk factors for refractoriness of these strictures.
  
  
  OBJECTIVE
  This study aimed to assess the risk factors associated with refractory strictures.
  
  
  METHODS
  This is a retrospective study of patients with benign esophageal strictures who were referred for esophageal dilatation over a period of 3 years.
  
  
  RESULTS
  A total of 327 esophageal dilatations were performed in 103 patients; 53% of the patients reported dysphagia for liquids. Clinical success was achieved in 77% of the patients. There was a need for further dilatations in 54% of patients, being more frequent in patients with dysphagia for liquids [78 vs. 64%, P=0.008, odds ratio (OR) 1.930], in those with caustic strictures (89 vs. 70%, P=0.007, OR 3.487), and in those with complex strictures (83 vs. 70%, P=0.047, OR 2.132). Caustic strictures, peptic strictures, and complex strictures showed statistical significance in the multivariate analysis. Time until subsequent dilatations was less in patients with dysphagia for liquids (49 vs. 182 days, P<0.001), in those with peptic strictures (49 vs. 98 days, P=0.004), in those with caustic strictures (49 vs. 78 days, P=0.005), and in patients with complex strictures (47 vs. 80 days P=0.009). In multivariate analysis, further dilatations occurred earlier in patients with dysphagia for liquids [hazard ratio (HR) 1.506, P=0.004], in those with peptic strictures (HR 1.644, P=0.002), in those with caustic strictures (HR 1.581, P=0.016), and in patients with complex strictures (HR 1.408, P=0.046).
  
  
  CONCLUSIONS
  Caustic, peptic, and complex strictures were associated with a greater need for subsequent dilatations. Time until subsequent dilatations was less in patients with dysphagia for liquids and in those with caustic, peptic, and complex strictures.
authors: Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal.
authors: Eduardo
authors: E
authors: Rodrigues-Pinto
authors: Pedro
authors: P
authors: Pereira
authors: Armando
authors: A
authors: Ribeiro
authors: Susana
authors: S
authors: Lopes
authors: Pedro
authors: P
authors: Moutinho-Ribeiro
authors: Marco
authors: M
authors: Silva
authors: Armando
authors: A
authors: Peixoto
authors: Rui
authors: R
authors: Gaspar
authors: Guilherme
authors: G
authors: Macedo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D002057:Burns, Chemical / Q000150:complications / Q000601:surgery*; D002424:Caustics / Q000633:toxicity; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery*; D004106:Dilatation / Q000379:methods*; D004931:Esophageal Achalasia / Q000150:complications / Q000601:surgery; D004940:Esophageal Stenosis / Q000139:chemically induced / Q000209:etiology / Q000601:surgery*; D004942:Esophagitis, Peptic / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000601:surgery*; D011832:Radiation Injuries / Q000150:complications / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D002424:Caustics