DOES REFLUX CAUSE RINGS, OR STRICTURES THAT LOOK LIKE RINGS?
This is a clinical study aimed at assessing the relationship between gastroesophageal reflux (GER) and symptomatic lower esophageal (Schatzki) rings (LER). Twenty patients [18 male, two female (mean age 61)] were studied at one center over an unknown time period. Ten had failed previous dilation and 10 apparently presented for evaluation for the first time. Diagnosis of LER was made by radiograph in 14 and endoscopy in six. All patients were evaluated for frequency of heartburn and dysphagia and underwent upper endoscopy (GIF XQ scope), biopsy of esophageal mucosa 4–5 cm above the ring (rings were not biopsied), esophageal manometry, and 24‐h pH monitoring. Twenty‐five controls were studied with manometry and 15 with pH monitoring. The age of controls is not reported. The study was not blinded. Heartburn was present at least monthly in 17/20 (85%). Dysphagia was present for a mean of 4.5 yr. We are not told whether patients had pure solid dysphagia or liquid and solids. All patients had endoscopic hiatal hernias (mean length 3.8 cm). Nineteen patients completed 24‐h pH monitoring. Twelve (63%) had abnormal GER. Neither upright, supine, or total reflux time are reported. Length and frequency of episodes are not mentioned. Endoscopy was abnormal in nine of 12 with increased GER, grade II in 8, grade I in one. Biopsies also were abnormal. Barretts esophagus was not seen. Three patients had abnormal GER and normal endoscopy, although mild esophagitis was seen on biopsy in these three. Seven patients had normal endoscopy and 24‐h pH monitoring studies. LES pressure was no different in LER patients versus controls. However (not surprisingly), patients with esophagitis did have lower pressure than controls. Likewise, distal esophageal amplitude was no different in LER patients versus controls, although, again, patients with esophagitis had lower distal amplitude. Nonspecific motor disorders were seen in five patients, including nontransmitted contraction, simultaneous contractions, and segmental simultaneous contractions. The authors suggest that the high incidence of reflux esophagitis (endoscopic and pH) supports their belief that GER is an important cause of progressive “stricturing” and of symptoms in patients with LER. They use the term ring strictures or strictured LER to describe the problems in patients studied, and suggest that reflux may be responsible for recurrent dysphagia requiring periodic redilation in some patients with rings. Little contribution to symptoms appears to be related to the presence or motility disorders. Copyright © 1991, Wiley Blackwell. All rights reserved
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