Idiopathic esophageal strictures can occur in foals. Initial diagnosis based on clinical signs may be delayed because of other more frequent causes of dysphagia, including idiopathic dorsal displacement of the soft palate or nasal reflux of milk, cleft palate, or pharyngeal cysts. All cases of nasal discharge of milk in foals should be evaluated with endoscopy. Esophageal stricture in older horses or ruminants typically results from mucosal ulceration secondary to esophageal obstruction. Appropriate treatment depends on whether the stricture is mucosal or mural (involving the muscular wall). Mucosal strictures can be treated conservatively with dietary management (see Esophageal Obstruction in Large Animals), bougienage with a cuffed endotracheal tube, or surgery. Mural strictures are best managed with esophageal myotomy. Surgical treatment of mucosal strictures may involve esophagotomy through the strictured area with insertion of a nasogastric tube, resulting in a traction diverticulum, mucosal resection and anastomosis, or full-thickness esophageal resection and anastomosis.