ults because in
reality the bougie is in a pocket of the suprastrictural eccentric
dilatation.]

_Symptoms_.--Dysphagia, regurgitation, distress after eating, and loss
of weight, vary with the degree of the stenosis. The intermittency of
the symptoms is sometimes confusing, for the lodgment of relatively
large particles of food often simulates a spasmodic stenosis, and in
fact there is often an element of spasm which holds the foreign body
in the strictured area until it relaxes. Static esophagitis results in
a swelling of the esophageal walls and a narrowing of the lumen, so
that swallowing is more or less troublesome until the esophagitis
subsides.

_Esophagoscopic Appearances of Cicatricial Stenosis_.--The color of
the cicatricial area is usually paler than the normal mucosa. The
scars may be very white and elevated, or they may be flush with the
normal mucosa, or even depressed. Occasionally the cicatrix is
annular, but more often it is eccentric and involves only a part of
the circumference of the wall. If the amount of scar tissue is small,
the lumen maintains its mobility; opens and closes during respiration,
cough, and vomiturition. Between two strictures there is often a pouch
containing food remnants. It is rarely possible to see the lumen of
the second stricture, because it is usually eccentric to the first.
Stagnation of food results in superjacent dilatation and esophagitis.
Erosions and ulcerations which follow the stagnation esophagitis
increase the cicatricial stenosis in their healing.

_Differential Diagnosis_.--When the underlying condition is masked by
inflammation and ulceration, these lesions must be removed by frequent
lavage, the administration of bismuth subnitrate with the occasional
addition of calomel powder, and the limitation of the diet to strained
liquids. The cicatricial nature of the stenosis can then be studied to
better advantage. In most cases the cicatrices are unmistakably
conspicuous. Spasmodic stenoses are differentiated by the absence of
cicatrices and the yielding of the stenosis to gentle but continuous
pressure of the esophagoscope. While it is possible that spasmodic
stenosis may supplement cicatricial stenosis, it is certainly
exceedingly rare. Nearly all of the occasions in which a temporary
increase of the stenosis in a cicatricial case is attributed to an
element of spasm, the real cause of the intermittency is not spasm but
obstruction caused by food. This occurs in