Clinical and manometric features of the lower esophageal muscular ring

OBJECTIVE: In contrast to the well-recognized Schatzki's ring, the lower es ophageal muscular ring remains a poorly defined entity. The purpose of this study is to report on the clinical features of three patients with lower e sophageal muscular rings and review the literature on this disorder, to bet ter understand its importance as a cause of dysphagia. METHODS: Three patients presenting to the West Roxbury VA Medical Center we re identified as having a contractile, focal narrowing in the distal esopha gus by upper GI series. Clinical histories were obtained and endoscopic and manometric evaluations were performed. RESULTS: The three patients had symptoms consisting of chronic, intermitten t dysphagia for both liquids and solids. The results of barium swallows and upper endoscopic examinations were similar and revealed a focal, thick con striction of variable luminal diameter located a few centimeters above the squamocolumnar junction. Esophageal motility testing revealed peristaltic, high-amplitude, long-duration, and multiple peaked contractions. Lower esop hageal sphincter function was normal. The patients derived partial or only temporary relief of dysphagia with esophageal dilation with rigid dilators. All three patients had significant symptomatic responses to anticholinergi c agents. CONCLUSIONS: Lower esophageal muscular rings are an uncommon but important cause of dysphagia. Significant esophageal motility abnormalities can be fo und in symptomatic patients. Distinguishing the lower esophageal muscular r ing from the Schatzki's ring is important because of differences in the tre atment and outcome of the two conditions.