Long-Term Treatment of Peptic Esophageal Stenosis with Dilatation and Cimetidine: Factors Influencing Clinical Result

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Abstract
Surgical treatment of severe peptic esophageal strictures is a serious problem in high-risk cases. Conservative treatment has to be considered as an alternative. In a prospective study, 33 patients were treated with dilatation of the stricture and a long-term medication with 4 × 400 mg cimetidine from 1977 to 1982. 28 patients were followed up for 6 months-6 years. 16 patients showed a good result (clinical stages I and II). 5 patients needed no further dilatation, but had significant symptoms (stage III). 4 patients had to be operated on because of serious symptoms and rapid restenosis. The clinical result was significantly less favorable in patients who took cimetidine irregularly or discontinued it (p < 0.001) than in patients with good compliance. In addition, the result of endoscopy was poorer in poor compliance and the frequency of bougienage was greater than when cimetidine was taken regularly. Age, sex or initial length and diameter of the stricture did not significantly influence the outcome. We conclude that conservative treatment of peptic esophageal strictures yields good long-term results in 85% of patients, provided that a high dose of cimetidine is taken on a life-long basis.