Sgouros Spiros N, Vlachogiannakos Jiannis, Karamanolis George, Vassiliadis Konstantinos, Stefanidis Gerasimos, Bergele Christine, Papadopoulou Euthimia, Avgerinos Alec, Mantides Apostolos
Department of Gastroenterology, Athens Naval and Veterans Hospital, Athens, Greece.
Am J Gastroenterol. 2005 Sep;100(9):1929-34. doi: 10.1111/j.1572-0241.2005.41184.x.
Distal esophageal (Schatzki's) rings are a frequent cause of dysphagia. Bougienage is generally effective, but relapses are common. The aim of this study was to evaluate the effect of long-term antisecretory therapy on the relapse rate of lower esophageal rings after successful bougienage with Savary dilators.
The study was performed on 44 consecutive patients with symptomatic Schatzki's rings, detected endoscopically, and/or radiologically. Graded esophageal dilation was performed as an outpatient procedure in a single session. After appropriate assessment with esophageal manometry and 24-h ambulatory esophageal pH monitoring, patients with documented GERD (n = 14) were treated with long-term omeprazole therapy. The remaining patients were blindly randomized to receive maintenance treatment with either omeprazole (group A-15 patients) or placebo (group B-15 patients). The necessity for redilation after documentation of the ring with endoscopy and/or radiology was considered as a relapse of the ring. The relapse rate was evaluated in all groups.
All bougienages were performed without significant side effects. Eight patients (8 of 44, 18.2%) had one or more relapses after a mean (SD) of 19.0 (10.1) months. Patients with (n = 14) or without (n = 30) GERD were comparable with respect to sex, age, body mass index, cigarette and alcohol consumption, diameter of the esophageal lumen at the level of the ring, resting lower esophageal sphincter pressure, duration of dysphagia, need for taking antacids during the follow-up period, and duration of follow-up. There were no recurrences of Schatzki's ring in the group of patients with documented GERD (follow-up [mean +/- SD]: 43.8 +/- 9.3 months, range: 27-62). In group A (follow-up [mean +/- SD]: 37.1 +/- 17.1 months, range: 11-66), one patient relapsed after 13 months, while in group B (follow-up [mean +/- SD]: 34.3 +/- 14.6 months, range: 10-58), seven patients relapsed after a mean (SD) of 19.9 (10.6) months. The actuarial probability of relapse was higher in patients without therapy (group B) (p= 0.008).
Our data support the hypothesis that, in patients with symptomatic Schatzki's rings, acid suppressive maintenance therapy after bougienage may prevent relapse of the ring.
食管远端（沙茨基氏）环是吞咽困难的常见原因。探条扩张术通常有效，但复发很常见。本研究的目的是评估长期抑酸治疗对使用萨瓦里扩张器成功进行探条扩张术后食管下环复发率的影响。
本研究对44例经内镜和/或放射学检查发现有症状的沙茨基氏环患者进行。在门诊单次进行分级食管扩张术。在通过食管测压和24小时动态食管pH监测进行适当评估后，确诊为胃食管反流病（GERD）的患者（n = 14）接受长期奥美拉唑治疗。其余患者被随机分为两组，一组接受奥美拉唑维持治疗（A组 - 15例患者），另一组接受安慰剂治疗（B组 - 15例患者）。在内镜和/或放射学检查证实环存在后再次扩张的必要性被视为环的复发。评估所有组的复发率。
所有探条扩张术均无明显副作用。8例患者（44例中的8例，18.2%）在平均（标准差）为19.0（10.1）个月后出现一次或多次复发。有GERD（n = 14）和无GERD（n = 30）的患者在性别、年龄、体重指数、吸烟和饮酒情况、环水平处食管腔直径、静息时食管下括约肌压力、吞咽困难持续时间、随访期间服用抗酸剂的必要性以及随访持续时间方面具有可比性。确诊为GERD的患者组中未出现沙茨基氏环复发（随访[平均±标准差]：43.8±9.3个月，范围：27 - 62个月）。在A组（随访[平均±标准差]：37.1±17.1个月，范围：11 - 66个月），1例患者在13个月后复发，而在B组（随访[平均±标准差]：34.3±14.6个月，范围：10 - 58个月），7例患者在平均（标准差）为19.9（10.6）个月后复发。未接受治疗的患者（B组）复发的精算概率更高（p = 0.008）。
我们的数据支持这样的假设，即对于有症状的沙茨基氏环患者，探条扩张术后的抑酸维持治疗可能预防环的复发。
