Esophageal Stricture in a Patient with Epidermolysis Bullosa Acquisita: Endoscopic and Medical Management

Abstract

Background: This 40-year-old man with extensive and severe epidermolysis bullosa acquisita (EBA) developed an esophageal stricture that caused dysphagia and limited his nutritional intake. Objective: The purpose of the evaluation and management was to relieve the symptomatic obstruction so that he could better swallow food and medications. Methods: Endoscopic visualization of the stricture allowed for balloon dilation to be effected. The radial forces applied probably allowed for a less traumatic intervention than the linear shearing forces of bougienage. Results: The stricture widened and immediately provided less dysphagia and better tolerance in ingesting food. Medical treatment with sucralfate, known to bind to and protect ulcer bases, also improved his symptoms. Conclusions: Esophageal strictures are relatively uncommon in patients with EBA; however, when faced with a stricture in this or other scarring bullous diseases that affect the esophagus, endoscopic balloon dilation combined with postprocedure sucralfate offers improvement with advantages over older methods of intervention.