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Ann Thorac Surg 1984;37:103-107
© 1984 The Society of Thoracic Surgeons

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Articles

Lower Esophageal Ring: Experiences in Treatment of 88 Patients

From the Veterans Administration Medical Center and the University of Tennessee Center for the Health Sciences, Memphis, TN

^* Address reprint requests to Dr. Eastridge, Veterans Administration Medical Center (112A), 1030 Jefferson Ave, Memphis, TN 38104

The lower esophageal ring is an unusual clinical disorder of the esophagus and consists of a thin submucosal circumferential scar that forms in the lower esophagus. It is probably an acquired lesion resulting from repeated insults to the lower esophageal mucosa.

The symptom of dysphagia results from esophageal obstruction, and the degree of obstruction is directly related to the internal diameter of the ring. Episodic aphagia results from impaction of food at the site of the ring.

Since 1970, 88 patients have been seen with either dysphagia or episodic aphagia. Sixty-five with chronic limited reflux were treated primarily by oral dilation. Two of them required an antireflux procedure at a later date because of accentuation of reflux symptoms. Eighteen patients received surgical treatment initially because of severe reflux disease. Treatment consisted of interruption of the ring combined with an antireflux procedure. Five patients received no treatment.

Lower esophageal ring may be managed satisfactorily through oral dilation, resulting in relief of dysphagia. If reflux disease is present or is accentuated by dilation and cannot be controlled medically, then the appropriate antireflux procedure should be done.

This article has been cited by other articles:

				J. B. Marshall, J. M. Kretschmar, and A. A. Diaz-Arias Gastroesophageal Reflux as a Pathogenic Factor in the Development of Symptomatic Lower Esophageal Rings Arch Intern Med, August 1, 1990; 150(8): 1669 - 1672. [Abstract] [PDF]

				D. B. Skinner Technical and scientific advances in general thoracic surgery Ann. Thorac. Surg., January 1, 1990; 49(1): 14 - 25. [PDF]

				W. Silber Lower Esophageal Ring Ann. Thorac. Surg., November 1, 1984; 38(5): 536 - 536. [PDF]