METHODS: From the UK General Practice Research Database, we identified patientswith a stricture diagnosis recorded between 1994 and 2000. Diagnoses wereconfirmed by general practitioner-completed questionnaires. Patients with stricturewere compared to an age- and sex-matched sample of controls from the original source population. We estimated the incidence of stricture, potential risk factors and comorbidities, and relative risk (RR) for subsequent stricture recurrence and mortality.

RESULTS: The incidence of esophageal stricture was 1.1 per 10000 person-years and increased markedly with age. Incidence of stricture decreased from 1994-2000, concomitant with a substantial increase in proton pump inhibitor (PPI) use. The majority of stricture cases (68%) were peptic. Prior dysphagia, gastroesophageal reflux disease (GERD), hiatus hernia, peptic ulcer disease and heavy alcohol use wereassociated with an increased risk of stricture. The rate of stricture recurrence was 11.1 per 100 person-years. Risk of recurrence associated with long-term PPI use adjusting for other factors was 0.6 (95% confidence interval: 0.3-1.1). Mortality in patients with peptic stricture was similar to that in the control population.

CONCLUSIONS: Esophageal stricture is a rare event, and most cases in primary care are peptic strictures. Prior GERD, hiatus hernia and peptic ulcer are associated with an increased risk of peptic stricture. Incidence of stricture decreased from 1994-2000.