Oesophageal Patients Association
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Stricture/dilatation

Hi all....after 2-3 weeks of very, very bad pain, sickness, nausea, dry retching, and complete loss of appetite, I underwent a barium swallow which showed a stricture/long narrowing just below the pylorus into the duodenum. I was shown the images and it was very narrow. It showed that liquid was getting through but no solid food was passing. There was a solid food residue in the gastric tube which must have been from a couple of days earlier as I had only been having liquids/soups since then. I was booked for a dilatation - just 2 days after the barium test, but the surgeon told me after that he could not see anything to dilate. Back to square one now. Is it possible that the sedation used for the procedure (I assume it was Midazolam) could actually relax the muscle causing the narrowing to temporarily disappear? Can such a stricture suddenly disappear overnight? My symptoms are back again and I’m worried that nothing will be done as I can’t function properly and need to go back to work. I have read a few posts mentioning Botox. Desperate for a solution as i’ve no idea how such a stricture would suddenly not be there at the dilatation procedure! Thanks as always!

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I had narrowing and underwent stretch with botox. Worked well for a few months but the pain returned and I had a 2nd session recently which seems to have done the job, my surgeon did say that one may not be enough. So far so good. Hope you get sorted soon, keep talking to the surgeon there is clearly a problem.

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Have you had your oesophagus removed surgically? If so, the pyloric sphincter quite often has to be stretched or opened with a myotomy / cut to allow food to pass through better.

It is not a good thing to have a dilatation without good reason, as the sphincter is there to prevent the contents of your digestive tract rising, so I can understand the surgeon not doing the dilatation when they could not see the problem.

But your real question is whether at the dilatation procedure the problem had 'disappeared'. If so, it suggests that the problem is there sometimes, but not at others. Which in turn would suggest that it might be something to do with how the system relaxes, perhaps connected with the nerve system that controls the sphincter. Or perhaps the presence of food triggering off a reaction that closes the sphincter valve.

If it is anything like achalasia that affects the lower oesophageal sphincter (a great speculation on my part), relaxation can make a contribution to how the system works. It is feasible that there would be medication that might help your situation, and that is what you are suggesting about the Midazolam effect.

So I think that what you are suggesting could be right, so I think that you need to contact the clinic and ask for further investigation. It might be that they decide to prescribe some medication to test how your system reacts.

Meanwhile I suggest that you keep a food diary and avoid food that has skins, a stringy texture or anything that might 'clog'. Sometimes these things do improve over time, but that is in itself optimistic speculation.

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Thanks so much for the great replies. Yes, I forgot to mention that I had the Ivor Lewis in 2016 (and the subsequent problems seem never-ending!)

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