The Annals of Thoracic Surgery, Vol 37, 103-107, Copyright © 1984 by The Society of Thoracic Surgeons
Lower esophageal ring: experiences in treatment of 88 patients
CE Eastridge, JW Pate and JA Mann
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.
