A 49-year-old woman comes to the physician with complaints of food getting stuck in her chest. It happens most often when she eats in a hurry and does not fully chew her food. She has no chest pain, abdominal pain, vomiting, heartburn, or weight loss. Her past medical history is not significant.
Barium esophagogram reveals a lower esophageal ring. She undergoes an endoscopic dilation procedure with complete relief of the symptoms. The remainder of the esophageal mucosa has no abnormalities.
Which of the following complications is the patient most likely to develop over the next 5 years?

Question

A 49-year-old woman comes to the physician with complaints of food getting stuck in her chest.  It happens most often when she eats in a hurry and does not fully chew her food.  She has no chest pain, abdominal pain, vomiting, heartburn, or weight loss.  Her past medical history is not significant.
Barium esophagogram reveals a lower esophageal ring.  She undergoes an endoscopic dilation procedure with complete relief of the symptoms.  The remainder of the esophageal mucosa has no abnormalities.
Which of the following complications is the patient most likely to develop over the next 5 years?

Quizplus · Accepted Answer

Esophageal (Schatzki) rings may be congenital or acquired (due to damage from gastroesophageal reflux) and account for 15%-30% of cases of dysphagia. Symptomatic patients frequently present with complaints of solid food dysphagia or reflux symptoms. Barium esophagram is more sensitive than endoscopy for diagnosing Schatzki rings because the rings are not easily visualized unless the lower esophagus is widely distended. First-line treatment involves endoscopic dilation for symptomatic relief. However, many patients develop recurrent symptoms usually starting after 1 year of therapy. More than 70%-80% of patients develop recurrence within 5 years. Thus, recurrence is a rule rather than an exception in these patients. Those with recurrent symptoms are treated with repeated dilation and acid suppression (eg, proton-pump inhibitors). Some studies have shown that patients with and without reflux symptoms treated with proton-pump inhibitors have fewer recurrences of symptoms. (Choice A) Eosinophilic esophagitis may be associated with esophageal rings, allergies, asthma, and atopic dermatitis. However, there is no association between Schatzki rings and isolated asthma/atopic symptoms. (Choice B) Esophageal dysmotility with dysphagia for both solids and liquids is not frequently associated with or a complication of esophageal rings. (Choice C) Gastric ulcers are associated with Helicobacter pylori infection and history of nonsteroidal anti-inflammatory drug use, but not usually with esophageal rings. (Choice D) Esophageal rings may possibly be associated with celiac disease and iron deficiency anemia, but they do not directly cause iron deficiency anemia. Educational objective: Patients with Schatzki rings maybe asymptomatic or present with dysphagia and/or reflux symptoms. Diagnosis is best confirmed with barium esophagram. Treatment includes dilation and acid suppression therapy, especially for patients with recurrent symptoms requiring repeated dilations. __________ References: Long-term recurrence rates following dilation of symptomatic Schatzki rings. (http://www.ncbi.nlm.nih.gov/pubmed/20976623) Long-term acid suppressive therapy may prevent the relapse of lower esophageal (Schatzki's) rings: a prospective, randomized, placebo-controlled study. (http://www.ncbi.nlm.nih.gov/pubmed/16128935)

A 49-Year-Old Woman Comes to the Physician with Complaints of Food