Issn Print: 0277-2116
Publication Date: 1997/10/01
CLINICAL CHARACTERISTICS OF PEDIATRIC PATIENTS WITH SCHATZKI'S RING: 65
K Husain; C Buonomo; K Buckley; S Nurko
Excerpt
Schatzki's ring is a rare thin submucosal circumferential ring in the lower esophagus. It has been well described in the adult population but no information in pediatrics is available. Aim: Describe the clinical characteristics of 11 children with a Schatzki's ring. Methods: The information was obtained from a retrospective review of the medical, radiological and endoscopic records. Results: There were 10 males, and 1 female. The mean age at presentation was 13 ± 3 years, and the mean duration of symptoms was 2.4 ± 2 years. Dysphagia was found in 6 (56%), food impaction in 7 (64%), chest pain in 4 (36%), abdominal pain in 2 (18%), vomiting in 2 (18%), and weight loss in 1 (9%). The UGI series showed the presence of the ring and a hiatal hernia in all. Endoscopically the ring was seen in 4 (36%), a hiatal hernia in 4 (36%), lower esophageal erythema in 10 (91%), and a lower esophageal ulcer in 3 (27%). Ten had biopsies and all had esophagitis, 2 (20%) mild, 5 (50%) moderate, and 3 (30%) severe. Mean follow up was 18 ± 12 months. Initial therapy was: Esophageal dilatation (ED) in 2, ranitidine (R) in 4, and omeprazole (O) in 5. After ED one had good results, and one had no follow up. Those on R had poor results, and were changed to O. Therefore O was given in 9, and follow up is available in 7: 3 became asymptomatic, 3 remained mildly symptomatic, and 1 had minimal improvement and required ED becoming asymptomatic. Relapse of symptoms was observed after long term follow up in 2 of the asymptomatic patients, one requiring multiple ED with poor response and the other responding to the addition of O. Conclusions: 1.Schatzki's ring should be suspected in patients with food impaction and/or dysphagia. 2. It can be missed endoscopically, so a barium study may be needed in patients with esophagitis and persistent dysphagia that do not respond to initial medical therapy. 3. The response to ranitidine is poor, so omeprazole should be considered. 4. Esophageal dilatation may be required if symptoms persist or the narrowing is severe 5. Few patients remain asymptomatic after long term follow up.
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