Effective Treatment of Symptomatic Lower Esophageal (Schatzki) Rings With Acid Suppression Therapy: Confirmed on Barium Esophagography.

OBJECTIVE: Symptomatic lower esophageal (Schatzki) rings are one of the most common causes of dysphagia and esophageal food impaction. Although these rings are often diagnosed fluoroscopically, patients are typically referred for dilation procedures performed by a gastroenterologist. Because these procedures are invasive and carry risks, including esophageal perforation, an alternative treatment option is needed. Although recent research has shown the effectiveness of acid suppression medications used in addition to dilation procedures, our objective was to evaluate the effectiveness of treatment with acid suppression medication alone.

MATERIALS AND METHODS: We retrospectively evaluated a cohort of nine patients who underwent barium esophagography at our institution to determine the ability to pass a 13-mm barium tablet and to identify a change in the lumen diameter of the lower esophageal rings after treatment with an oral proton pump inhibitor medication.

RESULTS: The median ring diameter was 10 mm (range, 8-15 mm) before treatment and 15 mm (range, 13-25 mm) after treatment, a statistically significant difference (p = 0.008). The median tablet passage score was 2 before treatment (with tablet passage paused briefly) and 1 after treatment (with the tablet passing through the esophagus easily without stopping), which was also a statistically significant difference (p = 0.02).

CONCLUSION: Significant improvements in both the ring lumen diameter and the ability to pass a tablet through the esophagus indicate that acid suppression medication is an effective alternative to the use of dilation procedures for the treatment of Schatzki rings.