Lower esophageal mucosal ring: correlation of referred symptoms with radiographic findings using a marshmallow bolus.

Abstract

OBJECTIVE. The purposeof this investigationwasto determinethe prevalenceof lower esophagealmucosal rings and to correlate the relationship between these mucosal rings and thepresenceandanatomiclevel of symptomsevokedusinga marshmallowbolus. SUBJECTS AND METHODS. Our prospective studyincluded130 patientswho under went bariumexaminationof the esophagus. All patientscompleteda questionnaireregarding the anatomic location of their symptoms of dysphagia. In addition to a multiphasic examina tion of the esophagus, all patients also underwent fluoroscopic observation and videotaping while swallowing a marshmallow bolus; any symptoms that were provoked were recorded.RESULTS. Lower esophageal mucosalringswere shownin 26 (20%) of the 130 patients. The diameterof the ringswas 9â€"12 mm in six patients,13â€"20 mm in 18 patients,and larger than 20 mm in two patients. In 16 (62%) of the 26 patients, a marshmallow bolus became im pacted at the ring; the impaction caused dysphagia in 12 (75%) of the I6 patients. In these 12 patients, dysphagia was referred to the neck in seven,the sternal angle in two, the mid chest in two, and the lower chest in one patient. None of the 12 patients had a pharyngeal or cervical esophageal abnormality that would account for their symptoms.CONCLUSION. Becauseproximal referral of symptomsis common in patientswith loweresophageal mucosalrings,a thoroughradiographicexaminationof theentireesophagus and esophagogastricregion is required regardlessof the level of their swallowing complaints.

Abdominal compression during endoscopy (the Bolster technique) demonstrates hidden Schatzki rings (with videos)

“…One technique entails having the patient perform the Valsalva maneuver in a prone position while swallowing solid food, and another requires swallowing a piece of marshmallow followed by liquid barium to determine whether symptoms are replicated. [5][6][7] However, these techniques are not possible in sedated patients. The main advantage of EGD compared with barium studies is the ability to obtain pathology, avoid radiation exposure, and perform therapeutic interventions.…”

“…The Valsalva maneuver and prone positioning permit identification of almost 100% of rings during barium studies. [5][6][7] By contrast, rings are not always visible on EGD, with 1 estimate suggesting that the sensitivity was only 58%. 5 As a result, some endoscopists perform empirical dilation in patients suspected of having a ring.…”

Membranas e anéis esofágicos

“…No diagnóstico diferencial, devem-se excluir as lesões esofágicas extrínsecas, estenose péptica, distúrbios motores e carcinoma de esôfago, os quais podem ser facilmente identificados com os exames anteriores 20,21,22 .…”

VIDEOFLUOROSCOPIC SWALLOWING STUDY: esophageal alterations in patients with dysphagia

“…The exam is used in many centers, but its value to also detect alterations on the esophageal phase is not clearly defined. Dysphagia may be part of the clinical picture of many esophageal disorders, and it may be perceived and reported by the patient at the cervical region (17) . Thus, in patients with cervical dysphagia, it becomes important to evaluate the esophagus during the VFSS to verify anatomical modifications and functional alterations (3,5) .…”