A randomized, prospective trial of electrosurgical incision followed by rabeprazole versus bougie dilation followed by rabeprazole of symptomatic esophageal (Schatzki's) rings.
BACKGROUND
Lower esophageal (Schatzki's) rings are a common cause of solid food dysphagia. Standard treatment involves passage of a single large bougie to disrupt the ring, but symptoms recur in the majority of patients. Electrosurgical incision of the ring may provide a longer duration of symptom improvement. There are no data on the treatment of Schatzki's rings in the presence of acid suppression treatment.


OBJECTIVE
Our purpose was to compare the efficacy of bougie dilation with electrosurgical incision of symptomatic Schatzki's rings at 1-year follow-up in the presence of rabeprazole treatment.


METHODS
Randomized, prospective trial.


METHODS
University of Utah Health Sciences Center and the Veterans Affairs Salt Lake.


METHODS
Fifty patients referred for endoscopic evaluation of dysphagia between January 2002 and March 2005.


METHODS
Symptom-free survival time (in months), dysphagia, and GERD scores.


RESULTS
Twenty-five patients each underwent bougie dilation and electrical incision and were followed up for 12 months. Symptom-free survival times were significantly longer in the incision group (7.99 months) compared with the bougie dilation group (5.86 months) (P = .03). Dysphagia and GERD scores significantly improved in each group comparing baseline with each time interval. The incision group had greater relief of dysphagia at 1 month (P = .05) compared with the bougie group. There was no difference between GERD scores in both groups.


CONCLUSIONS
Dysphagia and GERD symptoms were self-reported.


CONCLUSIONS
Electrosurgical incision of Schatzki's rings is safe and offers longer symptom-free survival compared with bougie dilation. The addition of rabeprazole offered significant improvement in GERD scores in both groups.
Wills
Jason C
JC
Division of Gastroenterology, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA.
Hilden
Kristen
K
Disario
James A
JA
Fang
John C
JC
D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D004106:Dilatation / Q000379:methods*; D004598:Electrosurgery / Q000379:methods*; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D004940:Esophageal Stenosis / Q000150:complications / Q000473:pathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D064750:Rabeprazole; D012720:Severity of Illness Index; D013237:Stereoisomerism; D013997:Time Factors; D016896:Treatment Outcome
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D004791:Enzyme Inhibitors; D064750:Rabeprazole