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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Most patients with Schatzki's ring have dysphagia that can be relieved by esophageal dilation. We report an unusual case in which dysphagia caused by a Schatzki ring could not be managed conservatively. The obstructing ring was excised through a gastrotomy approached by a left-sided thoracotomy. An antireflux procedure was done after elimination of the ring. Five years later, the patient remained symptom free.
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PMID:An unusually intractable Schatzki ring. 334 5

In 17 ambulatory patients with severe intermittent dysphagia an endoscopic electrosurgical radial incision of a Schatzki ring was made with a modified straight retractable sphincterotome. The incision was successfully accomplished with immediate relief of dysphagia in all patients. Fourteen patients remain asymptomatic with a mean follow-up of 46 months after the first treatment. Three patients required a second incision and they have been asymptomatic for more than 24 months. There was one mild bleeding episode. Endoscopic electrosurgical incision of the Schatzki ring is an effective therapeutic modality in selected patients.
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PMID:Late results in patients with Schatzki ring treated by endoscopic electrosurgical incision of the ring. 356 8

A total of 538 dilations were performed upon 293 patients evaluated at our unit. Of these, 4.8 per cent had cervical webs, 3.0 per cent had cricopharyngeal dysfunction, 9.2 per cent had undetermined cause, 3.4 per cent had achalasia, 65.5 per cent had peptic strictures, 3.8 per cent had Schatzki's ring, 2.4 per cent had esophagitis, 6.1 per cent had postoperative strictures, 0.3 per cent had caustic stricture and 1.4 per cent had extrinsic compression. True dysphagia should always be investigated through a careful history, physical examination, barium study, endoscopy and, infrequently, esophageal manometry.
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PMID:Endoscopic evaluation of dysphagia in two hundred and ninety-three patients with benign disease. 669 9

There are many options as to the accuracy of a patient's subjective localization of an obstructing esophageal lesion. However, there are few studies specifically examining this issue. Over a 35-month period, all patients evaluated by our gastroenterology service undergoing endoscopy for dysphagia were prospectively identified. The patient's subjective localization for the level of obstruction was evaluated by an investigator blinded to the results of prior barium esophagography and recorded on a schematic of the bony skeleton. At the time of endoscopy, the most proximal level of the obstructing lesion was documented. In all, 139 patients with dysphagia and an esophageal stricture were evaluated. Barium esophagograms were performed prior to endoscopy in all but nine patients (6.5%). The most common lesions causing dysphagia were carcinoma (34.5%), gastroesophageal reflux disease (22.3%), and a Schatzki's ring (15.8%). The level of obstruction was localized exactly in 30 patients (21.6%), within +/- 2 cm in 72 (52%), and within +/- 4 cm in 31 additional patients (74%). Eight patients (15%) with a distal esophageal lesion localized the obstruction to the proximal esophagus, whereas only two patients (5%) with a lesion in the proximal esophagus localized the level of obstruction to the distal esophagus. Overall, patients with distal obstructing lesions were more likely to have referral > 6 cm proximally than proximal lesions with referral to the distal esophagus (P = 0.003). There were no significant differences in accuracy based on the cause of dysphagia. In conclusion, a patient's subjective localization of the level of an esophageal stricture is highly accurate. Patients appear to be most accurate in localizing proximal rather than distal lesions.
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PMID:Localization of an obstructing esophageal lesion. Is the patient accurate? 758 88

History taking is the first step in the evaluation of a patient. An analysis of the information obtained provides the basis for the choice and order of diagnostic tests. In addition, it provides the clinician with the necessary information to determine the relevance of "abnormal tests" to the patient's problem. Dysphagia is a reliable symptom that indicates an abnormality in the swallowing mechanism. The history should contain a detailed description of the symptoms associated with dysphagia from the onset. Especially relevant are questions to determine if dysphagia is experienced every day or intermittently, with solid food or liquids or both, as well as presence and timing of associated symptoms such as, choking, coughing and regurgitation, changes in speech, heartburn and chest pain. It is clinically useful to divide swallowing into three phases: oral, pharyngeal and esophageal. Oral dysphagia is usually due to a neurologic disorder, decreased salivary flow or painful oropharyngeal lesions. Pharyngeal dysphagia is most frequently caused by neuromuscular disorders and less frequently by a Zenker's diverticulum, neoplasm or a mucosal web. Esophageal dysphagia is caused by a structural narrowing, such as produced by a peptic stricture, neoplasm or a Schatzki's ring or by a primary motility abnormality, such as achalasia or diffuse esophageal spasm or by motility abnormalities produced by inflammation caused by gastroesophageal reflux, medication-induced esophageal ulceration or infectious esophagitis.
Dysphagia 1993
PMID:Art and science of history taking in the patient with difficulty swallowing. 846 26

Schatzki's or lower esophageal ring (LER) is one of the most common causes of solid food dysphagia. These rings are associated with hiatal hernias and appear to be produced by an infolding at the junction between the squamous and columnar mucosa. The pathogenesis of LER is not clear, but may be related to gastroesophageal reflux disease (GERD), while GERD and pill injury may worsen the dysphagia associated with LER. LERs are best diagnosed with a combination of history and a carefully performed barium esophogram with solid bolus challenge. Therapy includes instruction in slow and careful mastication. Bougienage is the main form of treatment, but selected patients may require pneumatic dilation, electrosurgical techniques or surgical repair. GERD should be treated if present in these patients.
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PMID:Lower esophageal (Schatzki's) ring: pathogenesis, diagnosis and therapy. 890 18

Current recommendations for treatment of patients with symptomatic Schatzki's ring are based on anecdotal experience or uncontrolled studies. Maloney dilation is the gold standard. We performed a randomized controlled trial to compare the use of a single 52-Fr Maloney dilation versus four quadrant biopsy of Schatzki's ring for relief of dysphagia. The subjects answered standardized dysphagia-related questions on a scale of 0-5 (0 = no dysphagia; 5 = cannot handle secretions). To account for modifications in diet and eating habits, subjects answered 11 question to arrive at a eating/diet score. Patients with Schatzki's ring were randomized into one of the two protocols. Group 1 underwent endoscopic biopsies of the ring, one biopsy in each quadrant. In group 2, the endoscope was taken out, and a single 52-Fr Maloney dilation was performed. Twenty-six patients participated in the study and were followed for up to 15 months. There was no significant difference in age, sex, race, smoking, alcohol abuse, or medication intake between the two groups. Dysphagia score improved by 91% in both groups at three months and 84% and 85% at 12 months in groups 1 and 2, respectively. The eating/diet habit score improved by 78% in both groups. There was one failure in each group, and one recurrence at six months in the dilation group. Fifty-five percent of dilation group and 100% of biopsy group described the procedure as easy. There was no difference in the amount of sedatives used during the procedure or the acid blockers after the procedure. In patients undergoing endoscopy, the superior cost/safety profile of endoscopic biopsy makes it a preferred choice for treatment of Schatzki's ring over bougienage.
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PMID:Effectiveness of single dilation with Maloney dilator versus endoscopic rupture of Schatzki's ring using biopsy forceps. 1071 38

The lower esophageal mucosal ring, or Schatzki's ring, was first described by Templeton. Anatomically, it represents the lower end of the esophagus. Patients classically present with intermittent dysphagia to solids. Diagnosis is made by endoscopy or a barium esophagram. Gastroesophageal reflux disease has been suggested as an etiology. It can usually be treated by passing a large dilator. Further controlled studies are needed to study its cause.
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PMID:Schatzki's ring: a benign cause of dysphagia in adults. 1235 91

Schatzki's rings (SR) are a common cause of intermittent solid food dysphagia, but their etiology is unclear. Many believe they are related to acid reflux, hypothesizing that the rings act as a protective barrier against further reflux. The purpose of this study was to determine whether dilation of SR affected the degree of acid reflux. Twenty patients participated in the study. All patients underwent esophageal manometry and 24-hr pH monitoring off all acid inhibitory medications before and two weeks after esophageal dilation. No significant differences were noted in any of the reflux parameters measured before and after dilation. However, there was a trend toward reduction in symptom score in all patients, a decrease in Johnson-DeMeester score, and a decrease in supine reflux time in patients with thick SR after dilation. There was no correlation between ring diameter and the presence or absence of reflux. In conclusion, Schatzki's rings do not prevent esophageal reflux, and they may act to decrease esophageal acid clearance, especially in the supine position, thereby increasing esophageal acid exposure.
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PMID:Schatzki's rings do not protect against acid reflux and may decrease esophageal acid clearance. 1264 6

In the article by Schatzki published in 1963, data about the lower esophageal ring relate ring diameter to presence of dysphagia. Statistical analysis of these measurements was performed to quantify conclusions of Schatzki and to extract additional information from the data. Ring diameters in 332 patients with and without dysphagia are described in a histogram in the original article of Schatzki. Data were evaluated with analysis of variance, logistic regression, and receiver operating characteristic (ROC) analysis to quantify the relationship between ring diameter and dysphagia. Follow-up information was available in 36 symptomatic and 30 asymptomatic patients of Schatzki. Logistic regression indicated that there was a highly significant difference in ring diameter between the asymptomatic group and patients with recurrent dysphagia (P <.001) but not in patients who had a single episode of dysphagia at presentation (P =.229). Odds ratio of 0.686 indicated that a 1-mm increase in ring diameter decreased the likelihood of dysphagia by 31%; conversely, a 1-mm decrease in ring diameter increased the likelihood of dysphagia by 46%. ROC curve of sensitivity and specificity of ring diameter and symptoms showed that the 20-mm cutoff of Schatzki had a 96% (104 of 108) sensitivity and a 58% (130 of 224) specificity, with area under the ROC curve of 0.888. Retrospective statistical analysis of original data of Schatzki validated his major conclusions about the data. Some important questions remain unanswered because of missing data in the study of Schatzki.
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PMID:Schatzki ring, statistically reexamined. 1286 89


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