2 Non-Progressive dysphagia to both liquids and solids

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MCQ 144

Q. A 40 year-old female patient presented with dysphagia to both liquids and solids and regurgitation for 3 months. The dysphagia was non-progressive. What is the most likely diagnosis?

a) Caricnoma of the esophagus

b) Lower oesophageal mucosal ring

c) Achalasia cardia

d) Reflux esophagitis with esophageal stricture




ANSWER:
Answer here is B.... Not C...
In Achlasia, dysphagia is Progressive (read One Liner - 52)

In few cases of Shatzki ring- it has been seen to have dysphagia for both solids and liquids (though majority cases have dysphagia for solids only) ref: http://www.ajronline.org/content/171/5/1361.full.pdf

Also this could be a wrong recall and the option might be Lower oesophageal MUSCULAR ring -- if so then this can be the clear answer to the question -- ref : http://rajgoyal.com/Publications/2000-03.pdf

A Schatzki’s ring can be differentiated from the muscular ring based on several findings.
Firstly , Although both types of rings present with intermittent chronic dysphagia, the history of liquid dysphagia seen in our three patients is distinctly unusual with a Schatzki’s ring.
Secondly, the radiological picture in both disorders is of a concentric narrowing in the distal esophagus. However, the muscular ring has a greater, donut-like rather than washer-like thickness, and is characteristically situated a few centimeters proximal to the location of the Schatzki’s ring at the squamocolumnar junction.
Thirdly, the manometric findings of high-amplitude contractions of the esophageal body distinguish the muscular ring from the Schatzki’s ring, in which motility studies are typically normal (10, 11).
And fourth, the majority of patients with Schatzki’s rings derive immediate and long-lasting relief from esophageal dilation (12), whereas the patients with symptomatic muscular rings had incomplete, short-lasting symptom relief after dilation.


Schatzki and Muscular ring :
ref of image above : Click Here



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2 comments:

  1. Also its important to note : The Schatzki ring, a submucosal fibrotic thickening of the lower esophagus, occurs at the squamocolumnar junction

    ReplyDelete
  2. Achlasia Cardia has "non-progressive contraction" within the esophageal body but has "progressive dysphagia."

    ReplyDelete

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