SEVERE BENIGN ESOPHAGEAL STENOSIS IN A GERIATRIC PATIENT - PROGRESSIVE THERAPEUTIC FAILURE AND LIMITED LIFE SUPPORT: CLINICAL CASE ANALYSIS

Abstract

DOI: https://doi.org/10.46296/gt.v8i16.0268

Abstract

Benign esophageal stenosis is a common cause of chronic dysphagia in older adults, compromising the nutrition, hydration and quality of life of those who suffer from it. This condition is characterized by a non-malignant narrowing of the esophageal lumen, usually secondary to chronic inflammatory processes such as gastroesophageal reflux disease (GERD), prolonged exposure to drugs (such as non-steroidal anti-inflammatory drugs), or sequelae of previous treatments such as radiotherapy. In older people, chronic reflux and delayed gastric emptying, along with structural alterations of the esophagus, increase susceptibility to developing this pathology. In the clinical case described, a geriatric patient with a prolonged history of GERD is presented, in whom a stenosis of 2.5 cm was detected at the level of the distal esophagus, diagnosed by upper digestive endoscopy. Despite multiple attempts at treatment by means of endoscopic pneumatic dilatations, the condition evolved negatively, due to the context of clinical fragility of the patient, reflected in protein-caloric malnutrition, chronic anemia and progressive respiratory deterioration, which limited therapeutic effectiveness and increased the risk of complications. In elderly patients, the management of esophageal stenosis must be individualized, considering not only the anatomical lesion but also the patient's overall functional situation, comorbidity and life expectancy. Clinical guidelines recommend that, although dilations are effective in many cases, their repetition in fragile patients can generate more risks than benefits, especially if there is progression of functional deterioration or lack of sustained response to treatment.

Keywords: chronic dysphagia, reflux, stenosis, malnutrition, pneumatic dilatations.