Esophageal Dilatation

By Philip Clements, M.D., M.P.H., UCLA School of Medicine, Dept. of Rheumatology (originally published in "Scleroderma Voice," 2002 #3)

Question: What can you tell me about "throat-stretching"?

Answer: Actually the stretching occurs lower in the chest than in the throat. Generally the narrowing is at the end of the esophagus (the feeding tube that leads to the stomach) just before the esophagus joins the stomach. The reason that the narrowing (stricture or scarring) occurs is that the muscle that normally closes the esophagus from the stomach gets weak, and the opening between the esophagus and stomach remains open much too long a time. This allows hydrochloric acid acid (which is a very strong acid) and stomach juices to reflux (or back up) into the esophagus and actually "burn" the esophagus, much as strong acid might burn any tissue. As a result, there may be a scar that forms at the end of the esophagus.

Esophageal dilatation (or stretching) is the correct term for the procedure. A tube is passed through the mouth and down the esophagus, and actually stretches the narrowing at the end of the esophagus. This allows food to go down more easily.

Unfortunately, dilating the opening can also then allow stomach contents to reflux back into the esophagus. Nexium® and other proton-pump inhibitors (Prevacid®, Prilosec®, Protonix®, and Aciphex®) are very good at decreasing the amount of acid in the stomach juice. When stomach juice refluxes into the esophagus the juice is no longer acidic and, therefore, is much less likely to burn or scar the esophagus.