title: Lower esophageal mucosal ring: correlation of referred symptoms with radiographic findings using a marshmallow bolus.
abstract: OBJECTIVE
  The purpose of this investigation was to determine the prevalence of lower esophageal mucosal rings and to correlate the relationship between these mucosal rings and the presence and anatomic level of symptoms evoked using a marshmallow bolus.
  
  
  METHODS
  Our prospective study included 130 patients who underwent barium examination of the esophagus. All patients completed a questionnaire regarding the anatomic location of their symptoms of dysphagia. In addition to a multiphasic examination of the esophagus, all patients also underwent fluoroscopic observation and videotaping while swallowing a marshmallow bolus; any symptoms that were provoked were recorded.
  
  
  RESULTS
  Lower esophageal mucosal rings were shown in 26 (20%) of the 130 patients. The diameter of the rings was 9-12 mm in six patients, 13-20 mm in 18 patients, and larger than 20 mm in two patients. In 16 (62%) of the 26 patients, a marshmallow bolus became impacted at the ring; the impaction caused dysphagia in 12 (75%) of the 16 patients. In these 12 patients, dysphagia was referred to the neck in seven, the sternal angle in two, the mid chest in two, and the lower chest in one patient. None of the 12 patients had a pharyngeal or cervical esophageal abnormality that would account for their symptoms.
  
  
  CONCLUSIONS
  Because proximal referral of symptoms is common in patients with lower esophageal mucosal rings, a thorough radiographic examination of the entire esophagus and esophagogastric region is required regardless of the level of their swallowing complaints.
authors.affiliation: Department of Diagnostic Radiology, Wake Forest University School of Medicine and Baptist Medical Center, Winston-Salem, NC 27157, USA.
authors.forename: D F
authors.initials: DF
authors.lastname: Smith
authors.forename: D J
authors.initials: DJ
authors.lastname: Ott
authors.forename: D W
authors.initials: DW
authors.lastname: Gelfand
authors.forename: M Y
authors.initials: MY
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001466:Barium Sulfate; D003287:Contrast Media; D003679:Deglutition; D003680:Deglutition Disorders / Q000209:etiology; D004940:Esophageal Stenosis / Q000150:complications / Q000000981:diagnostic imaging*; D004947:Esophagus / Q000000981:diagnostic imaging*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000000981:diagnostic imaging; D011446:Prospective Studies
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate