Does aspirin or nsaid use influence the success of esophageal dilation in patients with gerd strictures?

Several studies suggest that approximately 60% of patients with strictures due to gastroesophageal reflux disease (GERD) regularly take aspirin or a non-steroidal anti-inflammatory agent (ASA/NSAID). It is unknown if these medications interfere with medical/endoscopic treatment. AIM: To determine if continued ASA/NSAID use portends a poor prognosis in patients with GERD strictures. METHODS: We collected pre and post dilation symptom scores in 50 patients (18F, 32M) with distal esophageal strictures. The dysphagia score was obtained by adding the dysphagia frequency (never=0, intermittently=1, weekly=2, daily=3) to the diet score (no problems=0, problems with selected solids-1, all solids=2, liquids=3). GERD was treated with aggressive medical therapy. Patients were gradually dilated to 45-48 F during repeated dilation sessions. Once achieving this goal, dilations were performed on a PRN basis. Patients not responding to initial dilation sessions received intralesional steroid injection. RESULTS: Prior to dilation, 30 patients (60%) were taking ASA/NSAID and 30 (60%) had poorly controlled heartburn. During the dilation period, 22 patients continued ASA/NSAID. Heartburn was well controlled in 45 of the 50 patients. The patients had a mean of 2.3 dilations. Only 3 patients were treated with intralesional steroids. Table displays mean dysphagia scores: Age Pre-dilation Post-dilation All Patients 60.5 4.24 1.34* No ASA/NSAID 57.1 4.42 1.39* Continued ASA/NSAID 67.2 4.18 1.27* *p< 0.001 in all groups comparing pre and post scores. Patients continuing ASA/NSAID were older; otherwise there were no significant differences. Once the dilation goal was achieved and heartburn was under good control, only 12 patients required 38 dilations with a mean follow-up of 15 months. CONCLUSIONS: 1) GERD strictures usually respond to aggressive medical/endoscopic therapy. 2) Discontinuation of ASA/NSAID does not appear to be necessary for a successful outcome.