Esophageal A‐ring is associated with the severity of gastroesophageal reflux
Yuval Nachalon MD Nogah Nativ‐Zeltzer PhD Shumon I. Dhar MD Omid B. Mehdizadeh MD Antonio T. Cassady BA Peter C. Belafsky MD
First published: 14 June 2019 https://doi.org/10.1002/lary.28143
Editor's Note: This Manuscript was accepted for publication on May 29, 2019.
The study will be presented in the ABEA 2019 Annual Meeting to be held during the Combined Otolaryngology Spring Meetings (COSM) in Austin, Texas, in May 2019.
The authors have no funding or conflicts of interest to declare.
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Abstract
Background
The esophageal A‐ring (EAR) is an anatomic finding appreciated on videofluoroscopic esophagram (VFE) at the junction of the tubular esophagus and esophageal vestibule. EARs are appreciated on a small subset (5%) of VFEs. We hypothesize that EARs represent a compensatory mechanism to protect against gastroesophageal reflux (GER).
Objective
To evaluate the association between EAR and GER.
Study Design
Case control study.
Methods
All persons having undergone ambulatory pH testing with an EAR identified on VFE between November 1, 2014 and June 30, 2014 were identified. All cases were matched to controls by age, gender, and the presence/absence of hiatal hernia. Subjective dysphagia severity was assessed with the EAT10 and the presence of erosive esophagitis and intestinal metaplasia on esophagoscopy was abstracted.
Results
The mean (±SD) age of the entire cohort (N = 20) was 63 (±7.7) years. 60% was female. The mean composite DeMeester pH score for persons with and without an EAR was 48.9 (±39.6) and 15.4 (±12.3), respectively (P = .033). The mean total % time of pH < 4 for persons with and without an EAR was 26.4 (±21.9) and 7.7 (±6.8), respectively (P = .034). The prevalence of erosive esophagitis among persons with and without an EAR was 70% and 10%, respectively (P = .019).
Conclusion
There is a significant association between the presence of esophageal A‐rings on esophagography and the severity of acid reflux on endoscopy and ambulatory pH testing. The data suggest that the presence of an esophageal A‐ring may be either a compensatory mechanism to protect against gastroesophageal reflux and/or an inflammatory consequence of peptic esophagitis.
Level of Evidence
3b Laryngoscope, 2019
Yuval Nachalon MD Nogah Nativ‐Zeltzer PhD Shumon I. Dhar MD Omid B. Mehdizadeh MD Antonio T. Cassady BA Peter C. Belafsky MD
First published: 14 June 2019 https://doi.org/10.1002/lary.28143
Editor's Note: This Manuscript was accepted for publication on May 29, 2019.
The study will be presented in the ABEA 2019 Annual Meeting to be held during the Combined Otolaryngology Spring Meetings (COSM) in Austin, Texas, in May 2019.
The authors have no funding or conflicts of interest to declare.
Read the full text
ePDFPDFTOOLS SHARE
Abstract
Background
The esophageal A‐ring (EAR) is an anatomic finding appreciated on videofluoroscopic esophagram (VFE) at the junction of the tubular esophagus and esophageal vestibule. EARs are appreciated on a small subset (5%) of VFEs. We hypothesize that EARs represent a compensatory mechanism to protect against gastroesophageal reflux (GER).
Objective
To evaluate the association between EAR and GER.
Study Design
Case control study.
Methods
All persons having undergone ambulatory pH testing with an EAR identified on VFE between November 1, 2014 and June 30, 2014 were identified. All cases were matched to controls by age, gender, and the presence/absence of hiatal hernia. Subjective dysphagia severity was assessed with the EAT10 and the presence of erosive esophagitis and intestinal metaplasia on esophagoscopy was abstracted.
Results
The mean (±SD) age of the entire cohort (N = 20) was 63 (±7.7) years. 60% was female. The mean composite DeMeester pH score for persons with and without an EAR was 48.9 (±39.6) and 15.4 (±12.3), respectively (P = .033). The mean total % time of pH < 4 for persons with and without an EAR was 26.4 (±21.9) and 7.7 (±6.8), respectively (P = .034). The prevalence of erosive esophagitis among persons with and without an EAR was 70% and 10%, respectively (P = .019).
Conclusion
There is a significant association between the presence of esophageal A‐rings on esophagography and the severity of acid reflux on endoscopy and ambulatory pH testing. The data suggest that the presence of an esophageal A‐ring may be either a compensatory mechanism to protect against gastroesophageal reflux and/or an inflammatory consequence of peptic esophagitis.
Level of Evidence
3b Laryngoscope, 2019
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