ROLE OF PPI IN PREVENTION AND TREATMENT OF ESOPHAGEAL STRICTURES OF VARIED ETIOLOGIES - A SYSTEMATIC REVIEW

Abstract

Background: Esophageal strictures, arising from diverse etiologies such as GERD, caustic injury, and post-radiation changes, remain a significant cause of morbidity. Proton pump inhibitors (PPIs) are commonly utilized to prevent and manage stricture formation due to their potent acid suppression. However, the breadth and consistency of evidence across various causes remain unclear. Aim:To systematically review and synthesize current evidence regarding the efficacy and safety of PPIs in the prevention and treatment of esophageal strictures of varied etiologies. Materials and Methods: A systematic review was conducted, analyzing 20 eligible articles retrieved from PubMed, Scopus, Embase, and Cochrane Library (2000–2023). Studies included randomized controlled trials, cohort, and case control studies evaluating PPI use for stricture prevention or treatment in adults. Data extraction focused on treatment success rates, effect sizes, safety profiles, and outcomes across etiological subgroups. Results: Across the 20 included studies, PPIs demonstrated significant efficacy in reducing the incidence and recurrence of esophageal strictures, with prevention/treatment success rates ranging from 13.1% to 81.0%. Most studies reported statistically significant improvements (effect sizes OR/RR >1, p<0.05). Efficacy was most pronounced in GERD-related strictures, with emerging benefits in post-caustic and post-radiation etiologies. Adverse effects were infrequently reported, but the need for vigilance in long-term use remains. Conclusion: PPIs play a pivotal role in the prevention and management of esophageal strictures across diverse etiologies, significantly reducing recurrence rates and improving patient outcomes. Nevertheless, heterogeneity in study design and outcome measures highlights the need for standardized, large-scale trials to further refine clinical recommendations.