Schatzki’s Ring/esophageal Spasm
(Gastroenterology 1999;117:229-32 & 233-54)
SCHATZKI’S RING
Definition:
Three types of rings:
A: muscular in origin, occurs about 2 cm proximal to GEJ
B (Schatzki’s): mucosal in origin, occurs at the squamocolumnar junction
C: nonpathologic anomaly caused by diaphragmatic indentation of the esophagus, rarely symptomatic
Etiologies:
Cause of A & B rings: unknown; May be associated with esophageal dysmotility; B rings may be reflux related
Clinical Manifestations/Physical Exam:
Patients usually describe intermittent solid-food dysphagia induced by hurrying a meal or anxiety
May present initially with foreign body impaction
Diagnostic Studies:
EGD
Treatments:
Esophageal dilation; Repeat treatment may be necessary over time
Dilation (selection based on stricture configuration, comfort of endoscopist, availability of equipment) Rule of 3’s: dilate a total of three times in one session (first dilation is the one with mild resistance) End point is a lumen diameter of >14 mm, followed by control of reflux (PPI) if any
Mercury-filled tapered bougies (Maloney): axial shearing and radial forces; best for simple symmetric strictures <10 mm
Guidewire placed tapered polyvinyl dilators (Savary): axial shearing and radial forces; best for <10 mm, long, tortuous, post-op strictures
Through-the-scope balloons (TTS): only radial force; best for <10 mm, long, tortuous, post-op strictures
Note: French sizes are circumferences sizes, divided by 3 they give the diameter in mm; So 30 Fr is 10 mm in diameter
ESOPHAGEAL SPASMS
Definition:
Esophageal motility disorder: a motility that differs significantly from accepted normal variations
Epidemiology: (See Chapter 1.17 for details on Manometry)
Primary Esophageal Motility Abnormalities:
Achalasia (a true disorder)
Absent distal peristalsis; Incomplete LES relaxation (residual >8 mmHg); High resting LES (>45 mmHg)
Diffuse Eso Spasm (DES)
Simultaneous contractions (>20% wet swallows); Some peristalsis; Repetitive (>3) & prolonged (>6 sec) contractions
Hypertensive peristalsis
“Nutcracker”: ↑ mid/distal peristaltic amplitude (total >180 mmHg); ↑ distal peristaltic duration (>6 sec) contractions
Isolated Hypertensive LES
High-resting LES (>45 mmHg); May be incomplete relaxation (residual pressure >8 mmHg)
Secondary Esophageal Motility Abnormalities:Related posts:
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