title: Schatzki's ring: to cut or break an unresolved problem.
abstract: Symptom assessment has been proven to be less reliable than barium pill testing for success of dilation of peptic strictures. Schatzki's ring also has a high recurrence rate. Our aim here was to compare the efficacy of single dilatation with a 54-F Savary dilator and electrosurgical ring incision for symptomatic Schatzki's rings. Schatzki's ring patients who failed to pass a 12.7-mm barium pill were randomized to dilatation with a 54-F Savary dilator or four quadrant incisions with a needle knife. All received lansoprazole (30 mg) for 30 days posttreatment. Follow-up at 1, 3, 6, and 12 months used the pill test and a dysphagia score. Eleven patients (mean age, 62; median, 64) were randomized and received therapy, six with dilatation and five with incision. The ring diameter pretherapy was 9.8 +/- 1.3 mm. One patient with dilatation had a procedure-related esophageal perforation. The dysphagia score decreased (from 2.7 +/- 1.1 predilatation and 3.0 +/- 0.4 preincision) to 0 after treatment, suggesting that both therapies were equally successful. In contrast, using objective measurements with the barium pill showed that the pill failed to pass the ring in 60% at 1 month after therapy. The failure rate by 1 year was 100%. Use of an objective measure of effectiveness of treatment of symptomatic Schatzki's rings showed that neither single large-dilator dilatation nor four quadrant ring incision was a reliable and effective therapy. In the future studies, repeated dilatation may be needed to define success before long-term outcome can be accurately assessed.
authors.affiliation: Department of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: Abeer
authors.initials: A
authors.lastname: Ibrahim
authors.forename: Rhonda A
authors.initials: RA
authors.lastname: Cole
authors.forename: Waqar A
authors.initials: WA
authors.lastname: Qureshi
authors.forename: Ahmed Z
authors.initials: AZ
authors.lastname: Helaly
authors.forename: Ali
authors.initials: A
authors.lastname: Jamecci
authors.forename: David Y
authors.initials: DY
authors.lastname: Graham
authors.forename: Kamran
authors.initials: K
authors.lastname: Ayub
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D004106:Dilatation / Q000379:methods; D004598:Electrosurgery; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D004940:Esophageal Stenosis / Q000601:surgery / Q000628:therapy*; D006801:Humans; D064747:Lansoprazole; D008875:Middle Aged; D009853:Omeprazole / Q000031:analogs & derivatives* / Q000627:therapeutic use; D054328:Proton Pump Inhibitors; D016896:Treatment Outcome
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D004791:Enzyme Inhibitors; D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D009853:Omeprazole