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Old 16 April 2020, 09:57
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Godzilla Godzilla is offline
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Schatzki Ring

Putting this out there in the event some have/is/may experience this condition.

Schatzki ring is: A Schatzki ring is a circular band of mucosal tissue that can form at the end of the food pipe closest to the stomach. The ring of tissue causes the food pipe, or esophagus, to narrow. When a ring forms, a person may have no symptoms. Or, they may have difficulty swallowing, which the medical community calls dysphagia. The difficulty may get worse when a person eats dry bread or meat. Schatzki rings are not cancerous, and they are usually harmless. Changing the diet and patterns of eating can help with symptoms.

Approximately a year and half ago, I was teaching on Bragg and released the students for a lunch break. The other cadre went out to grab some grub, I was by myself eating my chow. I started to choke and was experiencing spasms (hiccups) that was forcing the food up. I maintained airway, grabbed the phone and dialed 911 but did not push send as my symptoms were getting better. I made my way outside and found some dip bars and prepared myself to give self-Heimlich since the spasms started to get worse. I eventually vomited the food that was stuck. I noticed during the ordeal that the food wasn't stuck in my throat but lower towards my abdomen.

It kinda freaked me out but I thought it was a one-time occurrence. I had smaller bouts of the same thing about 8 months later, I still didn't think it was a big deal. Last Fall, I had a severe bout (45 mins) with my wife watching me struggle. Again, never loss of airway and just pushing out food. I made an appt and the Doc (not my regular one) gave me some acid reflux meds and didn't seem concerned.

Following another bout (later), I went and saw my regular Doc and he ordered an examination (Barium Swallow) through radiology. The cause of issues mentioned to me at that point ranged from nerve or tissue issues to cancer. I called to check on the results prior to leaving for a trip overseas but the Doc had not read the test results. I went overseas and did not get an email or call to clue me in on what was taking place. Upon return, I continued to experience the issue at least once a week.

I finally got seen at Gastro yesterday and they identified it as Schatzki ring. I have an Endoscopy in 10 days to exam couple areas in my stomach. We'll see what results.

Anyway, I want to put it out there in case anyone else deals with this issue. The Doc mentioned it is not uncommon for males my age (51) to experience this. The bottom of my esophagus has apparently shrunk. The hiccups results from the struggle that takes place in the area when the passage of food becomes pronounced.
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Old 16 April 2020, 10:38
Chesie Chesie is offline
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Schatzki's rings are pretty common, and the most common source of this narrowing is inflammation of the esophagus due to acid reflux. Getting an endoscopy is the appropriate next step. If it shows esophagitis (inflammation of the esophageal mucosa), then biopsies will be taken to look for Barrett's esophagus (pre-cancerous lesions of the esophagus that form in response to repeated acid reflux). If the narrowing of the esophagus is significant, they will balloon it, in order to widen the passage. More testing may follow, which could include checking muscle pressure in esophagus(manometry), and/or checking for the amount and frequency of acid reflux (pH or Bravo probe test). If the endoscopy findings are pretty mild, they may forego all the extra testing and just treat you with antacid medications.

Your symptoms are that of esophageal spasm, where the muscle contracts painfully, in response to food or acid refluxing into the esophagus. The likely source of your problem is acid reflux, which is treated by identifying the reason for the reflux. It can be due to increased acid production in your stomach, or an anatomical problem that has arisen.

Increased acid production: stress, helicobacter pylori infection (bacteria in stomach that stimulates acid production), and small tumors that cause unregulated production of acid in stomach (gastrinoma, which you almost certainly do not have. They are rare).

Anatomical problems: hiatal hernia (stomach doesn't stay in abdomen and slides into your chest), abdominal obesity, esophageal dysmotility issues (esophagus doesn't squeeze right, or propel food towards stomach properly).

Endoscopy is the next step. Common things being common, you likely have increased acid production causing your issues. If it is stress, you treat with a short course of antacid medication and address the stress. If it is because of helicobacter (they will test for this), you treat the infection with 2 weeks of antibiotic combination and antacids. If it is an anatomical problem, you see someone like me to get anatomy fixed.

On the civilian side, my practice is 99% upper GI surgery, and I deal with patients experiencing your problems every day of my life. If you have follow up questions, or questions about treatment plans put forth by your doctor, feel free to PM me.

Good luck,
Danny
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Old 16 April 2020, 10:44
AKAPete AKAPete is offline
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Wife had that and it was a mystery for a long while. You'd think diagnosing it would be simple.

Anyway the specialist found it and she had to go in for a procedure that (as far as I understand it) stretched it out. Out patient deal that total in and out was under 3 hours. Did put her under.

No problems since.
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Old 16 April 2020, 10:54
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Chesie and AKAPete-thanks for the feedback. The Doc told me I'd be under for a short time.

Chesie- will definitely hit you up if I have anymore questions. I've never heard of this condition and simply got tired of the increased dealings with the spasms and having to vomit. The internet mentioned meat and rice as something to be aware of. However, I have not seen where certain types of foods linked with my situation. Salads have caused a couple of episodes and fish the other day but overall, it varies.
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Old 16 April 2020, 11:16
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I'm glad they identified the problem. I hope they quickly identify a way forward.
Quote:
Originally Posted by Godzilla View Post
It kinda freaked me out but I thought it was a one-time occurrence. I had smaller bouts of the same thing about 8 months later, I still didn't think it was a big deal. Last Fall, I had a severe bout (45 mins) with my wife watching me struggle. Again, never loss of airway and just pushing out food. I made an appt and the Doc (not my regular one) gave me some acid reflux meds and didn't seem concerned.
She didn't try to help?!?
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Old 16 April 2020, 11:40
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Originally Posted by Gray Rhyno View Post
I'm glad they identified the problem. I hope they quickly identify a way forward.

She didn't try to help?!?
She handed me my will and asked me to update it real quick, not really. She was on her way to work but remained home ready to take me to the ER. Every time I experienced the deal, I figured it was related to choking so as long as I had airway, no panic was necessary. While she was concerned, I gave her the thumb's up to hang tight but let me pass the food.

As far as way forward, I'm on meds for now to deal with the acid. The procedure will identify other things allowing the Doc to work on a COA.
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Old 16 April 2020, 11:46
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Quote:
Originally Posted by Chesie View Post
Your symptoms are that of esophageal spasm, where the muscle contracts painfully, in response to food or acid refluxing into the esophagus. The likely source of your problem is acid reflux, which is treated by identifying the reason for the reflux. It can be due to increased acid production in your stomach, or an anatomical problem that has arisen.

Increased acid production: stress, helicobacter pylori infection (bacteria in stomach that stimulates acid production), and small tumors that cause unregulated production of acid in stomach (gastrinoma, which you almost certainly do not have. They are rare).

Anatomical problems: hiatal hernia (stomach doesn't stay in abdomen and slides into your chest), abdominal obesity, esophageal dysmotility issues (esophagus doesn't squeeze right, or propel food towards stomach properly).

Endoscopy is the next step. Common things being common, you likely have increased acid production causing your issues. If it is stress, you treat with a short course of antacid medication and address the stress. If it is because of helicobacter (they will test for this), you treat the infection with 2 weeks of antibiotic combination and antacids. If it is an anatomical problem, you see someone like me to get anatomy fixed.

Good luck,
Danny
I had similar symptoms as Godzilla and it turned out I had a hiatal hernia. However, my condition was complicated because approximately 75% of my stomach was in my chest cavity and inverted. My doc used a scope and pulled it down, reoriented it to the proper position and closed up the hernia with plywood and drywall. The procedure was over 3-hours and my surgeon used a scope via 5 holes into the abdomen. Took me about a two months to recover but the symptoms that Godzilla mentioned are mostly gone except for a little bit of acid reflux which I treat with OTC meds.

Godzilla, staying fit and lean will also help you with the acid reflux. The symptoms were bad when I was out of shape and eating everything on the menu. A change of diet and fitness levels make a huge difference. Ever since my procedure (a year next month) I've dropped 3 pant sizes, down to a size 34" waist and I intermittent fast. I feel decades younger and I'm 56 next month.
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Old 16 April 2020, 11:54
8654maine 8654maine is offline
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What Chesie said.

Last edited by 8654maine; 16 April 2020 at 12:03.
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Old 16 April 2020, 12:11
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I have the same symptoms, had an upper GI determined that I had acid reflux damage, a ulcer on esophagus (biopsied benign) and they stretched the end of esophagus. While it sounds similar they never used the phrase Shatzki ring. Be advised that the stretching gradually wears off but doesn't seem to return to pre stretch constriction.
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Old 16 April 2020, 12:26
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Quote:
Originally Posted by Godzilla View Post
She handed me my will and asked me to update it real quick, not really.
LOL. Surprised she didn't tell you to suck it up and rub some dirt on it.
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Old 16 April 2020, 12:43
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CPTAUSRET CPTAUSRET is offline
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Quote:
Originally Posted by Chesie View Post
Schatzki's rings are pretty common, and the most common source of this narrowing is inflammation of the esophagus due to acid reflux. Getting an endoscopy is the appropriate next step. If it shows esophagitis (inflammation of the esophageal mucosa), then biopsies will be taken to look for Barrett's esophagus (pre-cancerous lesions of the esophagus that form in response to repeated acid reflux). If the narrowing of the esophagus is significant, they will balloon it, in order to widen the passage. More testing may follow, which could include checking muscle pressure in esophagus(manometry), and/or checking for the amount and frequency of acid reflux (pH or Bravo probe test). If the endoscopy findings are pretty mild, they may forego all the extra testing and just treat you with antacid medications.

Your symptoms are that of esophageal spasm, where the muscle contracts painfully, in response to food or acid refluxing into the esophagus. The likely source of your problem is acid reflux, which is treated by identifying the reason for the reflux. It can be due to increased acid production in your stomach, or an anatomical problem that has arisen.

Increased acid production: stress, helicobacter pylori infection (bacteria in stomach that stimulates acid production), and small tumors that cause unregulated production of acid in stomach (gastrinoma, which you almost certainly do not have. They are rare).

Anatomical problems: hiatal hernia (stomach doesn't stay in abdomen and slides into your chest), abdominal obesity, esophageal dysmotility issues (esophagus doesn't squeeze right, or propel food towards stomach properly).

Endoscopy is the next step. Common things being common, you likely have increased acid production causing your issues. If it is stress, you treat with a short course of antacid medication and address the stress. If it is because of helicobacter (they will test for this), you treat the infection with 2 weeks of antibiotic combination and antacids. If it is an anatomical problem, you see someone like me to get anatomy fixed.

On the civilian side, my practice is 99% upper GI surgery, and I deal with patients experiencing your problems every day of my life. If you have follow up questions, or questions about treatment plans put forth by your doctor, feel free to PM me.

Good luck,
Danny
Nice write up.

I have Barrett's esophagus, have had it for years. I am taking Lansoprazole twice daily for it.
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Old 16 April 2020, 13:09
Chesie Chesie is offline
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Quote:
Originally Posted by CPTAUSRET View Post
Nice write up.

I have Barrett's esophagus, have had it for years. I am taking Lansoprazole twice daily for it.
Sir,

If you still have Barrett’s esophagus, then you are not being treated appropriately. A history of Barrett’s is one thing, but to still have it is no bueno. Hopefully I just misunderstood you, and that you were diagnosed as having it, but that follow-up endoscopy after treatment showed resolution of the Barrett’s.

V/R,
Danny
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Old 16 April 2020, 14:55
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Quote:
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Sir,

If you still have Barrett’s esophagus, then you are not being treated appropriately. A history of Barrett’s is one thing, but to still have it is no bueno. Hopefully I just misunderstood you, and that you were diagnosed as having it, but that follow-up endoscopy after treatment showed resolution of the Barrett’s.

V/R,
Danny
Well hell, Danny, I thought that I still have it because I am still being prescribed Lansoprazole for it.

You Sir, make a lot of sense. I'll find out.

Gracias.

T
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Old 16 April 2020, 23:44
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I started to pass by this thread without reading. I'm glad I didn't though.

This sounds really familiar. I've had something similar happen a half dozen times or so. It's usually when I'm really hungry and start eating quickly. I'll get a quick succession of hiccup/burp type things, combined with pain behind my sternum. It's a pretty solid pain for a few minutes, until it suddenly clears and I can continue eating. It's caused me to throw up a time or two; it's like I have a burp that's stuck and I can't clear.

Looks like I have something to talk to my PCP about the next time I go in.
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Old 17 April 2020, 08:27
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And this is why I love this site.
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Old 17 April 2020, 12:02
13F/COLT 13F/COLT is offline
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I Had the same issue for many years, but after having a swallow test and having a camera down up my noise and down my throat the E.N.& T. doctor proscribed me Prilosec. I have only had one issue in two year and that was when I stopped taking the meds and realized they were helping.

That condition is scary, so many times when I would go into a new restaurant I was looking for the bathroom in cause I had to go get the food unstuck once I started eating.
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Old 20 April 2020, 10:38
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Way thanks for this as well. Been having some serious reflux problems meself. Some in the middle of the night are pretty scary where I start to aspirate gastric fluids! VA put me on Ranitidine HCL several years ago, but it has been making my problems worse!
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Old 20 April 2020, 11:04
Chesie Chesie is offline
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Way thanks for this as well. Been having some serious reflux problems meself. Some in the middle of the night are pretty scary where I start to aspirate gastric fluids! VA put me on Ranitidine HCL several years ago, but it has been making my problems worse!
You should follow up with your GI doc for this. Aspiration of gastric fluids at nighttime is no good. Antacid medication does not prevent aspiration at all; it just changes the acidity of the fluid you are aspirating.
v/r,
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Old 20 April 2020, 12:35
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Quote:
Originally Posted by Chesie View Post
You should follow up with your GI doc for this. Aspiration of gastric fluids at nighttime is no good. Antacid medication does not prevent aspiration at all; it just changes the acidity of the fluid you are aspirating.
v/r,
Danny
Chesie,
Can you expand on the rebound effect from coming off PPI's? Do you use a step down approach?
Should folks prescribed those make sure they take them as prescribed for the time prescribed, etc.
V/R
litepath.
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Old 20 April 2020, 13:01
Chesie Chesie is offline
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Chesie,
Can you expand on the rebound effect from coming off PPI's? Do you use a step down approach?
Should folks prescribed those make sure they take them as prescribed for the time prescribed, etc.
V/R
litepath.
Rebound is a common phenomenon, and patients that take antacids for a long period of time (like more than a few months) need to taper down on the dose of antacid medication. This allows the stomach cells to adapt to the lower pH (higher acid) that ensues, after stopping acid suppression.

We try not to keep patients on antacids long-term, as we prefer to address the reason for symptoms and correct that problem. But I do prefer that patients take the whole course of antacid medication and not stop when they "feel better". The rationale for this is because healing time for ulcers/inflammation in stomach or esophagus takes longer than symptoms would suggest, and stopping before the inflammation/ulcer is healed will increase chance of ulcer coming back.

I cannot stress enough the importance of treating the underlying problem and not just treating the symptoms. You are just kicking the proverbial can down the road, and running the chance that the problem is worse and harder to treat later in the game.

If you get some heartburn that you never had before, go get some pepcid complete and chew a couple of those. If the problem goes away after a couple doses, good. Stop the pepcid. If you find yourself going thru a bottle of 30 chewables, and you still have symptoms, go see a GI doctor and get scoped. Home treatment has failed at this point, and you really do need to see a doctor.

The philosophy that, if pepcid doesn't work, you need "the big guns" of Prilosec or Nexium, is no bueno. At least, not without first establishing the correct diagnosis. Unfortunately, this diagnosis cannot be established via internet chat.

V/R,
Danny
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