Intermittent Dysphagia for Solids Associated with a Multiringed Esophagus: Clinical Features and Response to Dilatation |
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Authors: | Greta Shao-Chu Lee Philip Ian Craig John Saul Freiman David de Carle Ian James Cook |
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Institution: | (1) Department of Gastroenterology, The St. George Hospital, Kogarah, New South Wales, 2217, Australia |
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Abstract: | The entity of the multiringed esophagus, generally presenting in adults as intermittent dysphagia for solids, is relatively
uncommon and its pathogenesis is unknown. The goal of this study was to describe the demographic, clinical, and endoscopic
features of patients presenting with this condition, their response to esophageal dilatation, and the relationship of multiple
esophageal rings to eosinophilic esophagitis. Between 1989 and June 2004, 32 patients at this adult hospital fulfilled the
following inclusion criteria: (1) intermittent dysphagia for solids, (2) multiple esophageal rings at endoscopy, and (3) esophageal
dilatation(s) performed. Response to esophageal dilatation was measured by need for subsequent dilatations. Seventy-five percent
of the patients were male. Median age at onset of dysphagia was 21 years and at presentation 36.5 years. All had multiple
rings in the proximal or midesophagus on endoscopy and had undergone a total of 73 esophageal dilatations with no esophageal
perforations. Median maximal dilator size was 15 mm; however, 16% developed significant esophageal mucosal tears even with
11-mm dilators. Sixty-six percent required repeat dilatation, with the median time interval before recurrence being 8 months.
Eosinophilic esophagitis (mucosal eosinophil count > 20/HPF) was present in 50% of this cohort. From this study we conclude
that a multiringed esophagus causing intermittent dysphagia occurs predominantly in young males, responds well to dilatation,
but repeated dilatations are often necessary. Dilatation can lead to extensive mucosal tears and should be performed with
caution. Eosinophilic esophagitis is commonly but not invariably associated with this entity. Frequent relapse of dysphagia
highlights the need for effective pharmacotherapy. |
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Keywords: | Dysphagia Multiringed esophagus Esophageal dilatation Eosinophilic esophagitis Deglutition Deglutition disorders |
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