DOCSLIB.ORG

Schatzki Ring

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Schatzki Ring Schatzki ring A Schatzki ring is a ring of tissue near the end of the food pipe (esophagus) just above the opening to the stomach. Many people have them and don't know it, because most of the time Schatzki rings don't cause symptoms. The area with the ring is narrower than the rest of the food pipe. Symptoms may occur when food gets caught at the ring before reaching the stomach. This can happen when solid food, such as steak or bread, isn't chewed enough. A Schatzki ring can cause chest pain or a feeling that the food is stuck and won't move into the stomach. After the food moves into the stomach, the symptoms go away. In more severe cases, the food gets stuck and the person must bring the food back up before they can eat normally again. When a Schatzki ring causes ongoing swallowing problems, a doctor may use an endoscope or dilator to stretch or open the ring. SchatzkiDiagnosis Ring A Schatzki ring is a ring of tissue near the end of the foodLower pipe (esophagus)esophageal just rings above may the be opening diagnosed to the clinicallystomach. Manyand confirmedpeople by barium swallow (a have them and don’t know it, because most of the time radiologicalSchatzki rings study don’t causeto assess symptoms. swallowing) and upper endoscopy (using a tube to enter the mouth in order to view the esophagus and stomach). The area with the ring is narrower than the rest of the food pipe. Symptoms may occur when food gets caught at the ring before reaching the stomach. This can happen when solid food,Treatment such as steak or bread, isn’t chewed enough. A Schatzki ring can cause chest pain or a feeling that the food is stuck and won’t move into the stomach. After the food moves into the stomach, the symptoms go away. In more severe cases, the food getsThe stuck majority and the ofperson symptomatic must bring thepatients food back can upbe before treated they with can theeat passage of dilators, which normally again. open the mucosal ring. Single dilations of symptomatic lower esophageal rings are safe, easily performed, and well tolerated. Recurrences can be successfully treated by repeated dilations. When a Schatzki ring causes ongoing swallowing problems, a doctor may use an endoscope or dilator to stretch or open the ring. Diagnosis Lower esophageal rings may be diagnosed clinically and confirmed by barium swallow (a radiological study to assess swallowing) and upper endoscopy (using a tube to enter the mouth in order to view the esophagus and stomach). Treatment The majority of symptomatic patients can be treated with the passage of dilators, which open the mucosal ring. Single dilations of symptomatic lower esophageal rings are safe, easily performed, and well tolerated. Recurrences can be successfully treated by repeated dilations. 1015 S. Hackett Rd., Waterloo, Iowa 50701 Barbara Burkle, ARNP Ravi Mallavarapu, MD Tracy Elliott, ARNP Srinivas Kalala, MD 319.234.5990 Kelli DeSerano, ARNP Arun Muthusamy, MD Suhag Patel, MD CVMS complies with applicable Federal civil rights laws and does not Moaz Sial, MD discriminate on the basis of race, color, national origin, age, disability, or sex. CedarValleyGI.com SPANISH : ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. CHINESE : Rev. 1-9-20.
Load more

Recommended publications
  • Annular Pancreas Causing Gastric Outlet Obstruction in Adult: a Case Study
    IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 15, Issue 4 Ver. IX (Apr. 2016), PP 05-06 www.iosrjournals.org Annular Pancreas Causing Gastric Outlet Obstruction in Adult: A Case Study Dr Shyam Charan Baskey1, Dr Ramchandra Besra1,Dr Niranjan Mardi1, 2 2 Dr Shital Malua , Dr Pankaj Bodra 1Senior Resident,1Ex Senior Resident, 1Junior Resident1, 2Associate Professor Department of Surgery, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand India, Pin- 834009 Abstract: Annular pancreas is one of rare congenital anomalies that rarely manifest in adult. We hereby discuss our experiences with one of the presentation of annular pancreas. A 20 years male presented with pain abdomen symptom of gastric outlet obstruction, radiological investigation reported as chronic pancreatitis, on high level of suspicion exploratory laprotomy done with finding of annular pancreas. Bypass surgery done. Patients discharged uneventful. Key words: Annular pancreas, gastric outlet obstruction, CT scan, exploratory laprotomy. I. Introduction Annular pancreas is a congenital anomaly that consists of a ring of pancreatic tissue partially or completely obstructing second part of duodenum. It is formed due to failure of the ventral bud to rotate. Thus, it elongates and encircles the upper part of the duodenum, it can present in a wide range of clinical severities and can affect neonates to the elderly like peptic ulcer, pancreatitis, obstructive jaundice, gastric outlet obstruction etc, thereby making the diagnosis difficult, although diagnosis of annular pancreas can be made preoperatively by upper gastrointestinal endoscopy, CT scan, Endoscopic retrograde cholangiopancreatography (ERCP) and Magnetic resonance cholangiopancratography (MRCP).
    [Show full text]
  • Dysphagia What Is Dysphagia? Dysphagia Is a General Term Used to Describe Difficulty Swallowing
    Dysphagia What is Dysphagia? Dysphagia is a general term used to describe difficulty swallowing. While swallowing may seem very involuntary and basic, it’s actually a rather complex process involving many different muscles and nerves. Swallowing happens in 3 different phases: Insert Shutterstock ID: 119134822 1. During the first phase or oral phase the tongue moves food around in your mouth. Chewing breaks food down into smaller pieces, and saliva moistens food particles and starts to chemically break down our food. 2. During the pharyngeal phase your tongue pushes solids and liquids to the back of your mouth. This triggers a swallowing reflex that passes food through your throat (or pharynx). Your pharynx is the part of your throat behind your mouth and nasal cavity, it’s above your esophagus and larynx (or voice box). During this reflex, your larynx closes off so that food doesn’t get into your airways and lungs. 3. During the esophageal phase solids and liquids enter the esophagus, the muscular tube that carries food to your stomach via a series of wave-like muscular contractions called peristalsis. Insert Shutterstock ID: 1151090882 When the muscles and nerves that control swallowing don’t function properly or something is blocking your throat or esophagus, difficulty swallowing can occur. There are varying degrees of Dysphagia and not everyone will describe the same symptoms. Your symptoms will depend on your specific condition. Some people will experience difficulty swallowing only solids, or only dry solids like breads, while others will have problems swallowing both solids and liquids. Still others won’t be able to swallow anything at all.
    [Show full text]
  • The Gastrointestinal Tract Frank A
    91731_ch13 12/8/06 8:55 PM Page 549 13 The Gastrointestinal Tract Frank A. Mitros Emanuel Rubin THE ESOPHAGUS Bezoars Anatomy THE SMALL INTESTINE Congenital Disorders Anatomy Tracheoesophageal Fistula Congenital Disorders Rings and Webs Atresia and Stenosis Esophageal Diverticula Duplications (Enteric Cysts) Motor Disorders Meckel Diverticulum Achalasia Malrotation Scleroderma Meconium Ileus Hiatal Hernia Infections of the Small Intestine Esophagitis Bacterial Diarrhea Reflux Esophagitis Viral Gastroenteritis Barrett Esophagus Intestinal Tuberculosis Eosinophilic Esophagitis Intestinal Fungi Infective Esophagitis Parasites Chemical Esophagitis Vascular Diseases of the Small Intestine Esophagitis of Systemic Illness Acute Intestinal Ischemia Iatrogenic Cancer of Esophagitis Chronic Intestinal Ischemia Esophageal Varices Malabsorption Lacerations and Perforations Luminal-Phase Malabsorption Neoplasms of the Esophagus Intestinal-Phase Malabsorption Benign tumors Laboratory Evaluation Carcinoma Lactase Deficiency Adenocarcinoma Celiac Disease THE STOMACH Whipple Disease Anatomy AbetalipoproteinemiaHypogammaglobulinemia Congenital Disorders Congenital Lymphangiectasia Pyloric Stenosis Tropical Sprue Diaphragmatic Hernia Radiation Enteritis Rare Abnormalities Mechanical Obstruction Gastritis Neoplasms Acute Hemorrhagic Gastritis Benign Tumors Chronic Gastritis Malignant Tumors MénétrierDisease Pneumatosis Cystoides Intestinalis Peptic Ulcer Disease THE LARGE INTESTINE Benign Neoplasms Anatomy Stromal Tumors Congenital Disorders Epithelial Polyps
    [Show full text]
  • Identifying the LINX® Reflux Management System Patient
    Identifying the LINX® Reflux Management System Patient Gastroesophageal Reflux Disease, or GERD is a chronic What is GERD? digestive disease, caused by weakness or inappropriate relaxation in a muscle called the lower esophageal sphincter (LES). Normally, the LES behaves like a one-way valve, allowing food and liquid to pass through to the stomach, but preventing stomach contents from flowing back Symptoms of GERD into the esophagus. • Heartburn • Chest pain • Regurgitation • Dysphagia (difficulty swallowing) • Dental erosion and bad breath • Cough • Hoarseness • Sore throat • Asthma Complications * GERD can lead to potentially serious complications including: • Esophagitis (inflammation, irritation or swelling of the esophagus) • Stricture (narrowing of the esophagus) • Barrett’s esophagus (precancerous changes to the esophagus) • Esophageal cancer (in rare cases)** Diagnosing GERD • Response to medication • Endoscopy/EGD • Bravo pH monitoring *LINX is not intended to cure, treat, prevent, mitigate or diagnose these symptoms or complications **0.5% of Barrett’s esophagus patients per year are diagnosed with esophageal cancer ® Who is the LINX Reflux Management System patient? • Diagnosed with GERD as defined by abnormal pH testing • Patients seeking an alternative to continuous acid supression therapy LINX Reflux Management System patient workup • Objective reflux – pH testing • Anatomy – EGD • Esophageal function – Manometry Restore don’t reconstruct1* • Requires no alteration to stomach anatomy • Preserved ability to belch and vomit2† • Removable • Preserves future treatment options1‡ Patient benefits at 5 years1 • 85% of patients were off daily reflux medications after treatment with LINX Reflux Management System§ • Elimination of regurgitation in 99% of patients¶ • 88% elimination of bothersome heartburn** • Patients reported significant improvement in quality of life†† • Patients reported a significant improvement in symptoms of bloating and gas€ References 1.
    [Show full text]
  • UK Guidelines on Oesophageal Dilatation in Clinical Practice
    Gut Online First, published on February 24, 2018 as 10.1136/gutjnl-2017-315414 Guidelines UK guidelines on oesophageal dilatation in Gut: first published as 10.1136/gutjnl-2017-315414 on 24 February 2018. Downloaded from clinical practice Sarmed S Sami,1 Hasan, N Haboubi,2 Yeng Ang,3,4 Philip Boger,5 Pradeep Bhandari,6 John de Caestecker,7 Helen Griffiths,8 Rehan Haidry,9 Hans-Ulrich Laasch,10 Praful Patel,5 Stuart Paterson,11 Krish Ragunath,12 Peter Watson,13 Peter D Siersema,14 Stephen E Attwood15 ► Additional material is ABSTRACT 1.3 Obtain oesophageal biopsy specimens in published online only. To view These are updated guidelines which supersede the young patients with dysphagia or history please visit the journal online of food impaction to exclude eosinophilic (http:// dx. doi. org/ 10. 1136/ original version published in 2004. This work has gutjnl- 2017- 315414). been endorsed by the Clinical Services and Standards oesophagitis (GRADE of evidence: moder- Committee of the British Society of Gastroenterology ate; strength of recommendation: strong). For numbered affiliations see 1.4 Perform barium swallow in patients with end of article. (BSG) under the auspices of the oesophageal section of the BSG. The original guidelines have undergone suspected complex strictures (such as Correspondence to extensive revision by the 16 members of the Guideline post-radiation therapy or history of Professor Stephen E Attwood, Development Group with representation from individuals caustic injury) in order to establish the Department of Surgery, Durham across all relevant disciplines, including the Heartburn location, length, diameter and number University, Durham DH13HP, UK; Cancer UK charity, a nursing representative and a of strictures (GRADE of evidence: low; seaattwood@ gmail.
    [Show full text]
  • The GI Maladies – When and How to Treat, When to Refer Linda M
    The GI Maladies – When and How to Treat, When to Refer Linda M. Woodin, MSN, CRNP, BC Nurse Practitioner, Harrisburg Gastroenterology, Ltd. Harrisburg, PA GERD – symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus PATHOPHYSIOLOGY: 1. Lower esophageal sphincter 2. Intragastric pressure 3. Poor esophageal clearance 4. Altered esophageal mucosal barrier TREAT OR TEST? 20% of patients will reflux barium on UGI (false +) PPI Precautions: o With Clopidogrel o Long-term use UGI or referral for endoscopy for: o Non-responders o > age 65 o Red-flag conditions – dysphagia, odynophagia, chest pain, weight loss, anemia, melena, hematochezia, > 1 year of symptoms, bisphosphonates, NSAIDs, low-dose ASA , history of Barrett’s esophagus NON-CARDIAC CHEST PAIN Non-cardiac chest pain requires further diagnostics – UGI and/or EGD MOST COMMON CAUSES: Erosive esophagitis Odynophagia (including pill odynophagia) (minocycline, erythromycin) Esophageal spasm Achalasia = insufficient LES relaxation with loss of esophageal peristalsis and esophageal dilation (bird-beak appearance on UGI) If normal EGD -> esophageal manometry and 24 hour esophageal pH DYSPHAGIA/ODYNOPHAGIA: Dysphagia or odynophagia requires further diagnostics – barium swallow and/or EGD MOST COMMON CAUSES: o Esophagitis o Esophageal dysmotility o Hiatal hernia o Schatzki’s ring o Achalasia (LES insufficient relaxation with esophageal dilation o Medications (bisphosphonates, tetracyclines) HELICOBACTOR PYLORI Asymptomatic, but can cause chronic gastritis, PUD, gastric cancer (MALT – Mucosal Associated Lymphoid Tissue) TESTING: H pylori antibody IGG – does not reflect acute infection o Urea breath test – reliable o H. pylori fecal antigen – reliable o Testing during EGD – culture, modified Giemsa, rapid urease TREATING: o What drugs? o How much? o How long? If active infection detected, treatment and confirmation of eradication required If eradication unsuccessful, need to change treatment regimen Treating H.
    [Show full text]
  • Removal of Esophageal Variceal Bands to Salvage Complete Esophageal Obstruction
    CASE REPORT Clin Endosc 2018;51:491-494 https://doi.org/10.5946/ce.2018.011 Print ISSN 2234-2400 • On-line ISSN 2234-2443 Open Access Removal of Esophageal Variceal Bands to Salvage Complete Esophageal Obstruction Ala’ A Abdel Jalil, Ghassan Hammoud, Jamal A Ibdah and Sami Samiullah Division of Gastroenterology & Hepatology, University of Missouri-Columbia, Columbia, MO, USA Esophageal varices develop in almost half of the patients with cirrhosis, and variceal hemorrhage constitutes an ominous sign with an increased risk of mortality. Variceal banding is considered an effective and mostly safe measure for primary and secondary prophylaxis. Although adverse events related to banding including dysphagia, stricture formation, bleeding, and ligation-induced ulcers have been described, complete esophageal obstruction is rare, with only 10 reported cases in the literature. Among those cases, 6 were managed conservatively; 1 patient had esophageal intraluminal dissection from an attempt to remove the bands using biopsy forceps but ultimately recovered with conservative management. Three patients developed strictures following removal of the bands, requiring repeated sessions of dilation therapy. We report on a patient who developed absolute dysphagia and complete esophageal obstruction after variceal banding. We successfully used the endoloop cutter hook to release the bands intact and restore luminal integrity. Clin Endosc 2018;51:491-494 Key Words: Band ligation; Cirrhosis; Dysphagia; Esophageal obstruction; Endoscopy INTroDUCTION first variceal
    [Show full text]
  • Esophageal Intramural Pseudodiverticulosis with Food Impaction
    attila_8990.qxd 1/6/2006 3:41 PM Page 37 BRIEF COMMUNICATION Esophageal intramural pseudodiverticulosis with food impaction Tan Attila MD, Norman E Marcon MD FRCPC T Attila, NE Marcon. Esophageal intramural pseudodiverticulosis Pseudodiverticulose oesophagienne intramurale with food impaction. Can J Gastroenterol 2006;20(1):37-38. avec bouchon de nourriture Esophageal intramural pseudodiverticulosis is a rare condition of La pseudodiverticulose oesophagienne intramurale est une affection rare, unknown etiology originally described in 1960. It is characterized by d’étiologie inconnue, qui a été décrite pour la première fois en 1960. Elle multiple, flask-shaped outpouchings of pinhead size in the wall of the se caractérise par une multitude de diverticules de la grosseur d’une tête esophagus. Very small outpouchings on endoscopy and tiny collec- d’épingle, en forme de fiole, qui se trouvent dans la paroi de l’œsophage. tions of barium outside of the esophagus wall on esophagography are La présence de très petits diverticules à l’endoscopie et de minuscules typical diagnostic findings. During the era of widespread endoscopic amas de baryum à l’extérieur de la paroi de l’œsophage, à l’oesophagogra- and radiological evaluation of esophageal disorders, approximately phie, est un signe diagnostique caractéristique. À l’époque où l’évaluation 200 cases were published in the literature. A 52-year-old man with endoscopique et radiologique des troubles de l’œsophage était pratique esophageal intramural pseudodiverticulosis with food impaction is courante, on a fait état d’environ 200 cas dans la documentation médi- reported. The patient’s symptoms of dysphagia resolved with endo- cale.
    [Show full text]
  • Anatomical Description During Standard Upper Endoscopy
    Resident Corner Page 1 of 2 Anatomical description during standard upper endoscopy Ahmad Najdat Bazarbashi, Kelly E. Hathorn, Marvin Ryou Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, MA, USA Correspondence to: Ahmad Najdat Bazarbashi, MD. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, MA, USA. Email: [email protected]. Received: 15 January 2019; Accepted: 27 February 2019; Published: 18 March 2019. doi: 10.21037/aos.2019.03.01 View this article at: http://dx.doi.org/10.21037/aos.2019.03.01 In this video (Figure 1), we demonstrate standard upper endoscopy performed on a 50-year-old patient with history of gastroesophageal (GE) reflux disease and dyspepsia. We highlight the common anatomical landmarks of the upper Video 1. Anatomical description during gastrointestinal tract (Table 1, Figure 2) and endoscopic standard upper▲ endoscopy techniques for successful esophageal intubation, gastric Ahmad Najdat Bazarbashi*, Kelly E. Hathorn, retroflexion, duodenal access and tissue sampling using Marvin Ryou biopsy forceps. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Essentials of endoscopic reporting Boston, MA, USA Esophagus Figure 1 Anatomical description during standard upper endoscopy (1). Z line: regular vs. irregular; Available online: http://aos.amegroups.com/post/view/1550051583 Location of GE junction from incisors (example: 40 cm); Ease of scope passage through GE junction; extension to distal extension), malignant appearing, If varices present: grade, size, location, red wale sign or anterior vs. posterior wall or lesser curvature vs. greater white nipple sign (stigmata of bleeding); curvature, extension into esophagus or GE junction, Hiatal Hernia: size, from GE junction to diaphragmatic spontaneous bleeding or contact bleeding; pinch (example 35–40 cm), Hill classification; If gastritis is present: location, patchy vs.
    [Show full text]
  • Tom Frazierfrazier Objectivesobjectives
    TomTom FrazierFrazier ObjectivesObjectives AchalasiaAchalasia EverythingEverything inin ddsepddsep Pathophysiology SomeSome extrasextras Epidemiology VideoVideo Symptomatology Diagnosis Complications Treatment PathophysiologyPathophysiology degeneration of the myenteric inhibitory neurons imbalance between excitatory and inhibitory elements Intact cholinergic, excitatory neural function ? autoimmune response to a viral insult in genetically susceptible individuals HSV/Zoster/others Circulating autoantibodies Inflammatory infiltrate class II HLA DQw1 The American Journal of Gastroenterology Vol. 100, 6 Pages: 1404-1414 The American Journal of Gastroenterology Vol. 100, 6 Pages: 1404-1414 HistopathologyHistopathology ofof AchalasiaAchalasia Mild normal inflammation Loss of Severe inflammtion ganglion cells Walzer N, Hirano I. Gastroenterology Clinics - Volume 37, Issue 4 (December 2008) SecondarySecondary formsforms ofof achalasiaachalasia Achalasia Achalasia secondary to cancer Postoperative (antireflux fundoplication, bariatric (pseudoachalasia) gastric banding) Squamous cell carcinoma of the esophagus Allgrove's syndrome (AAA syndrome) Adenocarcinoma of the esophagus Eosinophilic esophagitis Gastric adenocarcinoma Hereditary cerebellar ataxia Lung carcinoma Familial achalasia Leiomyoma Sjogren's syndrome LyLymphomamphoma Sarcoidosis Breast adenocarcinoma Post vagotomy Hepatocellular carcinoma Autoimmune polyglandular syndrome type II Reticulum cell sarcoma Lymphangiomphangioma Achalasia with generalized motility disorder
    [Show full text]
  • Surgical Treatment of Gastroesophageal Reflux Disease
    Surgical Treatment of Gastroesophageal Reflux Disease a, b Robert B. Yates, MD *, Brant K. Oelschlager, MD KEYWORDS Gastroesophageal reflux disease Laparoscopic antireflux surgery Hiatal hernia Fundoplication KEY POINTS Gastroesophageal reflux disease is abnormal distal esophageal acid exposure that results in bothersome symptoms. It is caused by the failure of endogenous antireflux barriers, including the lower esophageal sphincter and esophageal clearance mechanisms. Appropriate preoperative patient evaluation increases the likelihood that gastroesopha- geal reflux disease–related symptoms will improve after laparoscopic antireflux surgery. In patients that have a clinical history suggestive of gastroesophageal reflux disease, diag- nostic testing should include ambulatory pH monitoring, esophageal manometry, esoph- agogastroduodenoscopy, and upper gastrointestinal series. Correct construction of the fundoplication reduces the risk of postoperative dysphagia caused by an inappropriately tight fundoplication, posterior herniation of gastric fundus, and slipped fundoplication. Recurrent symptoms of gastroesophageal reflux disease should be evaluated with esophageal manometry and ambulatory pH testing. Reoperative antireflux surgery should be performed by experienced gastroesophageal surgeons. INTRODUCTION Gastroesophageal reflux disease (GERD) is the most common benign medical condition of the stomach and esophagus. GERD is defined by abnormal distal esophageal acid exposure that is associated with patient symptoms. Most patients
    [Show full text]
  • New Duration of Use and Dose Limits for Proton Pump Inhibitors (Ppis)
    New duration of use and dose limits for Proton Pump Inhibitors (PPIs) Beginning June 1, 2017, Washington Apple Health (Medicaid), administered by the Health Care Authority (Agency) will limit PPIs to one tablet/capsule per day for 2 months during any 12-month period. The Agency may authorize more than 2 months per year and/or more than one tablet/capsule per day for patients taking certain medications or who have one of the chronic medical conditions listed below: Chronic medical conditions include: Pathological gastric acid hypersecretion, such as Zollinger-Ellison syndrome Barrett’s esophagus Esophageal stenosis/stricture or Schatzki ring Recent erosive/ulcerative esophagitis or duodenal/gastric ulcer Concurrent medications include: Chronic NSAID use (including aspirin greater than or equal to 325 mg per day) Chronic low-dose aspirin with history of a GI bleed Chronic high-dose systemic steroid Antiplatelet or anticoagulant Bisphosphonate where there are pre-existing esophageal disorders Pancreatic enzyme Cancer Therapies Why are we adopting these interventions? PPIs are commonly prescribed to treat gastroesophageal reflux disease (GERD) or heartburn and symptoms are generally well controlled after 60 days of PPI therapy, even when cases are more severe. PPIs are known to cause rebound acid reflux when patients try to abruptly discontinue using the PPI. This rebound reflux is often mistaken for continued need of the PPI and has led to overutilization. Overutilization is defined as using a PPI for longer than the FDA-recommended time period of 4 to 8 weeks. To avoid rebound acid reflux the PPI should be gradually discontinued and supplemented with a histamine-2 receptor blocker (H2RA) e.g.
    [Show full text]