Dysphagia due to multiple esophageal rings: DISCUSSION part2

The cause of the rings is unknown. Except for four patients who had heartburn, there have been no obvious predisposing factors such as iron deficiency, caustic ingestion, pemphigus or epidermolysis bullosa. No consistent abnormality of esophageal motility has been identified that can explain the development of rings. It has been suggested that the rings may be an unusual manifestation of otherwise occult gastroesophageal reflux.

This theory is supported by the histological findings of basal zone hyperplasia, intraepithelial eosinophils or both on microscopic examination and in abnormal pH studies in the few patients reported. However, medical antireflux treatment, even with omeprazole, has not affected the rings. One child bas been reported whose esophagus returned to normal following a fundoplication. A congenital origin is suggested in some cases by the very long duration ofsymp-toms. A congenital and possible familial origin is also supported by the report of multiple rings in a father and son. Another male child in that family died at age one week because of “an inability to swallow”. The potential etiological factors in the presented patient were his nasogastric intubation for one week after his motor vehicle accident and chest injury, and the endoscopic impression that his lower esophageal sphincter was incompetent. A pharmacy you can fully trust offering birth control alesse along with other convenient services.

The dysphagia caused by the rings is easy to treat by bougienage but some caution must be exercised. Of the 11 patients treated by bougienage seven experienced bleeding or an unusual degree of chest pain after dilation. Since in many of the cases the degree of esophageal narrowing prevented the passage of all but the smallest endoscope, it may be prudent not to dilate the esophagus to a normal diameter too quickly.

This entry was posted in Dysphagia and tagged Dysphagia, Esophagus, Rings, Webs.