Distal esophageal rings, or Schatzki's rings are a frequent cause of dysphagia.
Bougienage is generally effective, but relapses are common.
Dr Sgouros and colleagues from Greece evaluated the effect of long-term antisecretory therapy on the relapse rate of lower esophageal rings after successful bougienage with Savary dilators.
The researchers included 44 consecutive patients with symptomatic Schatzki's rings, detected endoscopically, and/or radiologically.
Graded esophageal dilation was performed as an outpatient procedure in a single session.
The research team conducted an appropriate assessment with esophageal manometry and 24-hour ambulatory esophageal pH monitoring.
|8 of 44 patients had relapses after a mean of 19 months|
|American Journal of Gastroenterology|
After this assessment, 14 patients with documented gastroesophageal disease (GERD) were treated with long-term omeprazole therapy.
The remaining patients were blindly randomized to receive maintenance treatment with either omeprazole in 15 patients in Group A or placebo in 15 patients in Group B.
The necessity for redilation after documentation of the ring with endoscopy and/or radiology was considered as a relapse of the ring.
The researchers evaluated the relapse rate in all groups.
The team reported that all bougienages were performed without significant side effects.
The researchers found that 8 of 44 patients had relapses after a mean of 19 months.
Patients with or without GERD were comparable with respect to sex, age, body mass index, cigarette and alcohol consumption, and duration of dysphagia.
The team also noted that patients with or without GERD were comparable with regards to diameter of the esophageal lumen at the level of the ring.
Resting lower esophageal sphincter pressure, the need for taking antacids during the follow-up period, and duration of follow-up were also similar in patients with or without GERD.
The researchers observed no recurrences of Schatzki's ring in the group of patients with documented GERD.
In group A, the team noted that 1 patient relapsed after 13 months, while in group B 7 patients relapsed after a mean of 20 months.
The actuarial probability of relapse was higher in patients not receiving therapy in Group B.
Dr Sgouros' team commented, “Our data support the hypothesis that, in patients with symptomatic Schatzki's rings, acid suppressive maintenance therapy after bougienage may prevent relapse of the ring.”