How are benign distal esophageal strictures typically treated?

• A. Endoscopic dilation with PPI therapy
• B. Antibiotics
• C. Surgery
• D. Observation only

Answer: (A)

Benign distal esophageal strictures are caused by scar tissue narrowing the passage, often from chronic acid exposure, so the goal is to relieve the obstruction and reduce ongoing injury to prevent recurrence. The best approach combines endoscopic dilation with acid suppression. Endoscopic dilation uses balloons or dilators to gradually widen the narrowed segment, which directly improves swallowing and outlet patency. Adding a proton pump inhibitor reduces acid in the esophagus, helping the healing process and lowering the likelihood that the stricture will reform. Antibiotics don’t address a noninfectious scar, so they aren’t appropriate here. Surgery is generally reserved for cases where dilation fails or the stricture is complex, not as the first-line treatment. Observation alone would leave the narrowing and symptoms unresolved.