In peptic reflux-related esophageal strictures, dilation is favored over medical therapy when there is a truly narrowed lumen causing symptomatic dysphagia.

• A. Mild reflux symptoms with no dysphagia.
• B. A truly narrowed lumen causing symptomatic dysphagia.
• C. Only regurgitation without dysphagia.
• D. Normal endoscopy with no narrowing.

Answer: (B)

In peptic reflux-related esophageal strictures, the key decision is guided by whether there is a true mechanical narrowing that blocks passage of food. When the lumen is genuinely narrowed and this causes symptomatic dysphagia, dilation is the best option because it directly relieves the obstruction by widening the scarred segment, improving bolus transit.

Medical therapy, like acid suppression, helps reduce ongoing reflux but does not fix a fixed narrowing. If the patient’s problem is a truly narrowed lumen with dysphagia, dilating the stricture addresses the root mechanical issue and provides symptomatic relief.

If symptoms are mild and limited to reflux without any dysphagia, there isn’t a fixed obstruction to relieve, so dilation isn’t indicated. Regurgitation without dysphagia also suggests reflux symptoms rather than a structural narrowing. A normal endoscopy with no narrowing shows no lumen to dilate, so dilation isn’t appropriate there.

So the best fit is a truly narrowed lumen causing symptomatic dysphagia, because it represents an actual mechanical obstruction that dilation can effectively treat.