title: Use of a marshmallow bolus for evaluating lower esophageal mucosal rings.
abstract: Sixty-three patients (35 women, 28 men; mean age 55 yr) with lower esophageal mucosal ring shown radiographically were examined with a semi-solid bolus consisting of a portion of a standard marshmallow. The most common symptom was dysphagia, present in 46 (73%) patients. Impaction of the marshmallow bolus by the ring occurred in 40 (63%) of the 63 patients, and produced symptoms in 27 (68%) of these 40 patients. Nine (14%) rings were detected radiographically only with a solid bolus; eight of these patients had dysphagia and seven rings were 20 mm or less in caliber. Impaction related to ring caliber, and was found in all 17 (100%) rings that were 13 mm or less in diameter, in 17/24 (71%) 14- to 19-mm rings, and in 6/22 (27%) rings 20 mm or more in caliber. Endoscopy in 23 patients detected 16 (70%) rings, and also depended on ring caliber: less than or equal to 13 mm, 6/6 (100%); 14-19 mm, 5/9 (56%); greater than or equal to 20 mm, 5/8 (63%). Marshmallow impaction occurred in 17 (74%) of 23 patients who had endoscopy; three of the 23 patients had normal endoscopy. In conclusion, radiographic examination supplemented by the use of a marshmallow bolus best detects lower esophageal mucosal ring.
authors.affiliation: Department of Radiology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina.
authors.forename: D J
authors.initials: DJ
authors.lastname: Ott
authors.forename: T F
authors.initials: TF
authors.lastname: Kelley
authors.forename: M Y
authors.initials: MY
authors.lastname: Chen
authors.forename: D W
authors.initials: DW
authors.lastname: Gelfand
authors.forename: W C
authors.initials: WC
authors.lastname: Wu
mesh_terms: D003251:Constriction, Pathologic / Q000150:complications / Q000000981:diagnostic imaging; D003680:Deglutition Disorders / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D004945:Esophagoscopy; D004947:Esophagus / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000000981:diagnostic imaging / Q000473:pathology; D011859:Radiography