Sean Novak MD, Presenter: Consultant, Custom Learning Designs, Inc

Michael J. Shortsleeve MD, Abstract Co-Author: Nothing to Disclose

Schatzki (lower esophageal) rings are a common cause of dysphagia and esophageal food impaction. While many of these rings are diagnosed radiographically on double-contrast fluoroscopic examinations, typical therapy involves referral to a gastroenterology specialist for procedural dilation with an endoscopic balloon or other device. The dilation procedures are invasive and expose the patient to the risk of esophageal perforation. There is a partial association between acid reflux and Schatzki rings, although many of these rings occur in patients without known gastroesophageal reflux disease. We hypothesized that medical treatment with acid-suppressive medications, particularly proton-pump inhibitors, might be a reasonable alternative for Schatzki ring treatment.

In this proof-of-concept study, we treated three patients who had symptomatic Schatzki rings with an oral proton-pump inhibitor (omeprazole) for a mean of 10 months (range 5 to 12 months). Double-contrast barium esophagrams were performed prior to and following treatment for all patients. In two patients, pre- and post-treatment 13 mm barium tablet swallowing testing was performed.

Prior to treatment, the mean Schatzki ring diameter was 11 mm (range 9 to 13 mm). After treatment, the mean ring diameter increased to 15 mm (range 14 to 15 mm). All patients reported subjective improvement in dysphagia symptoms. Of the two patients with 13 mm barium tablet swallow tested, pre-treatment the tablet paused at the ring for 3 minutes for the first patient, and briefly for the second patient. Post-treatment, the tablet passed easily without pause or obstruction for both patients. All patients tolerated the treatment well. There were no complications.

Acid-suppressive medication improves dysphagia symptoms and ring diameter in patients with symptomatic Schatzki rings, and is an effective alternative to procedural dilation.

Dysphagia in patients with Schatzki rings can be treated with acid-suppressive medication as an effective alternative or addition to procedural dilation.

Novak, S, Shortsleeve, M, Schatzki Ring Treatment with Acid-suppressive Medication Improves Symptoms and Ring Diameter.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13044121.html