P1823 - Factors Associated With Perception of Dysphagia in Patients With Widely Patent Schatzki Rings

Aaron B. Fein, DO, Hammad Qureshi, MD, Naba Saeed, MBBS, Ahmed Sobieh, MD, PhD, Bahaaeldeen Ismail, MD, MSc
University of Kentucky, Lexington, KY

Introduction: Schatzki rings are often encountered in practice, sometimes as asymptomatic, incidental findings. Dysphagia perception in this setting can be complex and multifactorial. The aim of this study is to evaluate the variables associated with dysphagia in patients with non-obstructing Schatzki rings (NOCR).

Methods: This was a retrospective study including patients ≥ 18 yo with NOCR (diagnosed via endoscopy and/or imaging) and underwent esophageal physiologic testing at our institution between October 2005 and October 2022. We excluded patients with achalasia, eosinophilic esophagitis, foregut surgery and those with inadequate quality studies. We compared the demographics, clinical, endoscopic, radiologic, and physiologic testing parameters among the dysphagia and no-dysphagia groups. To assess factors associated with dysphagia, we designed a multivariate logistic regression model including variables that are significant on univariate analysis and those with plausible clinical relevance to dysphagia.

Results: 86 patients met inclusion criteria. Demographics were comparable among the groups as well as endoscopic and radiologic findings (including ring size and barium transit time). Similarly, the integrated relaxation pressure (IRP), distal contractile integral (DCI) and ineffective peristalsis were not significantly different. There was higher acid exposure time (AET) in the dysphagia group (7.6 [0.6, 24.5] vs 1.55 [0.0, 13.7], p = 0.009) along with higher DeMeester (25.0 [3.6, 106.3] vs 8.8 [0.3, 62.0], p = 0.01) and longer acid reflux episodes (19.2 [2.6, 72.0] vs 3.6 [0.0, 64.2], p = 0.03). Even after exclusion of achalasia, dysmotility was still seen in 22 patients, with a trend towards higher odds of dysphagia with dysmotility on univariate analysis (OR 4.16, CI [1.06-27.7]) (fig 1a). The multivariate model initially included age, gender, body mass, hiatal hernia, AET, DCI, IRP, ring size and dysmotility. We then performed backward elimination to keep the most relevant variables. The final model (fig 1b) showed that acid exposure time had the highest odds of dysphagia (OR 2.11, CI [1.06-4.78], p = 0.046), while gender and DCI did not retain the statistical significance.

Discussion: Dysphagia was present in 72% of those with non-obstructive Schatzki rings. Ongoing acid reflux (rather than anatomical or motility parameters) appeared to be the greatest predictor of symptomatic dysphagia in these patients. However, prospective larger sample studies are needed to validate the finding.



Disclosures:


Aaron B. Fein, DO, Hammad Qureshi, MD, Naba Saeed, MBBS, Ahmed Sobieh, MD, PhD, Bahaaeldeen Ismail, MD, MSc. P1823 - Factors Associated With Perception of Dysphagia in Patients With Widely Patent Schatzki Rings, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.