Natural progression of the lower esophageal mucosal ring

Abstract

Among 390 patients with endoscopically verified lower esophageal mucosal ring (LEMR), 22 cases were identified with previous or subsequent radiologic examinations of the esophagogastric region. Among these, it was found that 2 cases of LEMR had developed from a normal esophagus. In 3 patients, there was increasing stenosis of the LEMR. In 8 cases, the LEMR was transformed into an esophageal stricture. In 10 of the 13 cases, esophagitis of varying degree was present endoscopically. In the 9 patients exhibiting no change in the LEMR, only 1 patient had esophagitis. The data suggest that there is a potential progression from normal esophagus to lower esophageal ring to esophageal stricture that occurs in association with reflux esophagitis.

Lower Esophageal (Schatzki’s) Ring: Pathogenesis, Diagnosis and Therapy

“…These were once thought to be congenital, but this is unlikely since they are rarely seen before the age of 40. The association of gas troesophageal reflux and these rings was sug gested in 1978 and recently supported when 13 of 20 patients studied by ambulatory pH testing had significant gastroesophageal reflux [12], In addition LERs have been shown to occasionally progress to a typical peptic esophageal stricture [13,14], In this same report patients were noted to progress from a normal esophagus to a LER. An additional analysis challenged this concept when it com pared patients with hiatal hernia and a ring to those with hiatal hernia alone and found sig nificantly less reflux in those with both the hernia and ring [15], An attempt to correlate LER with an abnormal lower esophageal sphincter pressure found no statistical rela tionship and therefore did not support an association between LER and abnormal esophageal motility or lower esophageal sphincter pressure [16], Finally, there are no data on the effect of antireflux therapy on the recurrence of esophageal rings, although both famotidine and omeprazole have been noted to decrease the recurrence of reflux-related strictures in separate reports [17,18], A prop erly designed, randomized trial of the effect of acid suppression on the recurrence of rings is needed.…”

Esophagus: anatomy and developmental and structural anomalies

“…Rings larger than 20 mm in diameter are usually asymptomatic, rings 13-20 mm in diameter cause variable degrees of dysphagia depending on type and size of bolus, and rings less than 13 mm in diameter frequently cause solid food dysphagia [136,137]. Serial esophagrams have demonstrated the development and progressive narrowing of lower esophageal mucosal rings, providing evidence that these are acquired and not congenital lesions [138][139][140]. Misunderstanding in the literature and in practice has resulted from confusing Schatzki rings with short annular peptic strictures and, more recently, eosinophilic esophagitis.…”

Ring(s)-related esophageal meat bolus impaction: biopsy first, dilate later

“…Asymptomatic SRs are found in 6–14% of barium swallow radiographs; symptomatic SRs occur in only 0.5% of all barium swallow examinations, but they account for 15–26% of esophageal dysphagia 1–3 . Progression of SR to peptic stricture suggesting a chronic injury from gastroesophageal reflux disease (GERD) as a causative factor has been demonstrated 4,5 . Typically, SR becomes symptomatic if the esophageal luminal diameter is less than 13 mm depending on the type and size of food bolus.…”

“…[1][2][3] Progression of SR to peptic stricture suggesting a chronic injury from gastroesophageal reflux disease (GERD) as a causative factor has been demonstrated. 4,5 Typically, SR becomes symptomatic if the esophageal luminal diameter is less than 13 mm depending on the type and size of food bolus. First line of therapy for SR is dilation with a large bougie (Ն50-French).…”