Esophageal Dilation In Patients Research Articles

Esophageal Dilation in Patients with Achalasia Is a Predictive Factor for the Inability to Traverse the Esophagogastric Junction with a Manometric Catheter

Introduction: The insertion of a high-resolution manometry (HRM) catheter into the stomach is essential for accurate manometric diagnoses; however, it is impossible in some cases due to the inability to traverse the esophagogastric junction (EGJ). Predictive factors for these patients have not been investigated in detail, necessitating time-consuming and burdensome procedures for investigators and patients. Therefore, the present study investigated the percentage of and risk factors for failed intubation at the EGJ. Methods: We initially reviewed the medical charts of consecutive HRM procedures performed at our hospital between September 2018 and January 2023. Patient characteristics and the findings of endoscopy and esophagography (where available) were compared between successful and failed procedures. A multivariate logistic regression analysis was conducted to identify predictive factors for the inability to traverse the EGJ. We then validated the predictive factors identified by reviewing consecutive procedures performed between February 2023 and August 2023. Results: Among the 781 procedures performed, 55 (7.0%) failed due to the inability to traverse the EGJ. Achalasia was the most common disorder in these procedures. An older age and dilated esophagus of >34 mm were independent predictive factors for the inability to traverse the EGJ in patients with treatment-naïve achalasia. In the validation study, 7 out of 68 procedures (10.3%) failed due to the inability to traverse the EGJ. A flowchart using the findings of endoscopy and an esophageal diameter of >34 mm predicted the inability to traverse the EGJ with a sensitivity of 71.4% and specificity of 86.9%. Conclusion: Based on an esophageal diameter >34 mm and endoscopic findings, we predicted the inability to traverse the EGJ in more than 70% of patients. A multi-center prospective study is warranted in the future.

Disease Burden and Unmet Need in Eosinophilic Esophagitis.

Eosinophilic esophagitis (EoE) is a chronic, progressive, type 2 inflammatory disease of increasing prevalence, characterized by symptoms of dysphagia and reduced quality of life. A dysregulated type 2 immune response to food and aeroallergen leads to barrier dysfunction, chronic esophageal inflammation, remodeling, and fibrosis. Patients with EoE have impaired quality of life because of dysphagia and other symptoms. They may also suffer social and psychological implications of food-related illness and expensive out-of-pocket costs associated with treatment. Disease burden in EoE is often compounded by the presence of comorbid type 2 inflammatory diseases. Current conventional treatments include elimination diet, proton pump inhibitors, and swallowed topical corticosteroids, as well as esophageal dilation in patients who have developed strictures. These treatments demonstrate variable response rates and may not always provide long-term disease control. There is an unmet need for long-term histologic, endoscopic, and symptomatic disease control; for targeted therapies that can normalize the immune response to triggers, reduce chronic inflammation, and limit or prevent remodeling and fibrosis; and for earlier diagnosis, defined treatment outcomes, and a greater understanding of patient perspectives on treatment. In addition, healthcare professionals need a better understanding of the patient perspective on disease burden, the disconnect between symptoms and disease activity, and the progressive nature of EoE and the need for continuous monitoring and maintenance treatment. In this review, we explore the progression of disease over the patient's lifespan, highlight the patient perspective on disease, and discuss the unmet need for effective long-term treatments.

Esophageal Dilatation in Patients with Esophageal Stricture Formation due to Corrosive Intake - Clinical Experience of Thoracic Surgery Department at A Tertiary Care Center

Objective: Assessment of the outcome of esophageal dilatation in patients with esophageal stricture formation due to corrosive intake experienced at a tertiary healthcare facility in order to devise a better management plan for such patients. Study design: Retrospective Study Study setting: Sheikh Zayed Medical College/Hospital, Rahim Yar Khan. Study duration: January 2018-June 2021 Methodology: A total of 19 subjects who presented with esophageal stricture formation due to corrosive intake were taken as study subjects. The location of involved mucosa, number of dilatation sessions done, level of symptomatic relief and recurrence rates were assessed for these study subjects. Then the data was gathered and analyzed with the help of SPSS Version. 21. Results: This study comprising of 19 patients who had esophageal stricture formed due to corrosive intake and they underwent esophageal dilatation for it. The age range for the subjects came out to be 5-40 years (Mean= 2.89±8.81). Male to female ratio came out to be 7(36.8%) vs 12(63.2%) respectively. Among these study subjects, 15(78.9%) subjects gave history of an acid ingestion while only 4(21.1%) had a history of alkali ingestion. Majority of them showed relief in response to esophageal dilatation and with low recurrence rates. Conclusion: Esophageal dilatation with bougies is one of the safest, less invasive, and efficient method for the effective management of esophageal stenosis/ stricture formation after corrosive intake that needs to be emphasized specially in healthcare centers which lack specialized departments dealing with more invasive surgical procedure and facilities. Keywords: Esophagus, Dilatation, Corrosive, Stricture, Acid, Alkali

2860 Safety of Esophageal Dilation in Patients With Eosinophilic Esophagitis in a Single Center Cohort

INTRODUCTION: Eosinophilic esophagitis (EoE), a chronic immune-mediated disorder, is a leading cause of food impaction due to fibrotic formation of rings, narrowing, and strictures. Historically, esophageal dilation (ED) was reserved as second-line therapy for EoE after failure of medical management, due to concern of complications, mainly perforation. Now, ED is recognized as an effective treatment for symptomatic relief. The aim of this study is to assess the safety of ED in a large cohort of EoE cases in a single center. METHODS: A retrospective review of patients with biopsy confirmed EoE at University of Iowa Hospitals and Clinics between the years 2006 – 2018 was conducted. All subjects met diagnostic criteria for EoE; presence of esophageal dysfunction and mucosal eosinophilic infiltration (≥15 eos/hpf). Histologic and clinical features, ED characteristics and related complications, and self-reported symptomatic improvement were extracted via chart review. Descriptive statistic with univariate analysis was performed. RESULTS: A total of 160 patients were dilated 295 times, ranging from 1-12 dilations per patient, with an average of 1.91 dilations per patient. 67 patients (41.88%) required >1 dilation. Procedures were generally tolerated well, with no major bleeds or perforations. The overall complication rate was 6.1%, primarily due to post-procedural chest pain (4.8%). Three patients had sedation related complications: one aspiration pneumonia and two ICU admissions for respiratory distress. Clinical improvement was documented in 87% of dilations on follow up. Table 1 and Figure 1 and 2. CONCLUSION: The prevalence of EoE is increasing with rates of 0.5 – 1 cases per 1000 individuals, with 25-35% of these patients requiring ED for symptomatic management. In the early 2000s, many reports suggested an increased procedure-related risk, including esophageal perforation. Recent systematic review and meta-analysis have shown otherwise. Present published rate of perforation in dilation in EoE occurs in < 0.3% of procedures, which approximates that of dilation for other benign esophageal indications. Our study is consistent with current data. Taking the above safety data of ED into account along with the rising incidence of EoE, lends evidence to the acceptance of ED as a safe and effective treatment. ED should therefore be considered a safe procedure in EoE patients for symptomatic management in addition to dietary and pharmacological interventions.

Office-based esophageal dilation in head and neck cancer: Safety, feasibility, and cost analysis.

To review experience, safety, and cost of office-based esophageal dilation in patients with history of head and neck cancer (HNCA). The medical records of patients undergoing esophageal dilation in the office were retrospectively reviewed between August 2015 and May 2017. Patients were given nasal topical anesthesia. Next, a transnasal esophagoscopy (TNE) was performed. If the patient tolerated TNE, we proceeded with esophageal dilation using Seldinger technique with the CRE™ Boston Scientific (Boston Scientific Corp., Marlborough, MA) balloon system. Patients were discharged directly from the outpatient clinic. Forty-seven dilations were performed in 22 patients with an average of 2.1 dilations/patient (range 1-10, standard deviation [SD] ± 2.2). Seventeen patients (77%) were male. The average age was 67 years (range 35-78 years, SD ± 8.5). The most common primary site of cancer was oral cavity/oropharynx (n = 10), followed by larynx (n = 6). All patients (100%) had history of radiation treatment. Four patients were postlaryngectomy. The indication for esophageal dilation was esophageal stricture and progressive dysphagia. All dilations occurred in the proximal esophagus. There were no major complications. Three focal, superficial lacerations occurred. Two patients experienced mild, self-limited epistaxis. One dilation was poorly tolerated due to discomfort. One patient required pain medication postprocedure. Office-based esophageal dilation generated $15,000 less in health system charges compared to traditional operating room dilation on average per episode of care. In patients with history of HNCA and radiation, office-based TNE with esophageal dilation appears safe, well-tolerated, and cost-effective. In a small cohort, the technique has low complication rate and is feasible in an otolaryngology outpatient office setting. 4. Laryngoscope, 128:2261-2267, 2018.

Role of Esophageal Dilation in Patients With Ineffective Esophageal Motility

Introduction: Ineffective Esophageal Motility (IEM)is diagnosed by manometry based on the strength of contractions in the esophagus. Patients with IEM may report dysphagia, angina, globus, regurgitation and acid reflux. The mechanism behind this diagnosis involves an imbalance of inhibitory and excitatory forces on the esophagus. Furthermore, there hasn't been sufficient evidence supporting any treatment. Esophageal dilation is frequently used in IEM patients with dysphagia. Objective: To evaluate effectiveness of esophageal dilation in relieving dysphagia in IEM patients. Methods: Retrospective cohort analysis of 130 adult patients with IEM between 2006 and 2015. Of the 130 patients with IEM, 37 underwent EGD with dilation. Of the 37 who were dilated, 31 returned for a follow-up appointment. Resolution or return of dysphagia was recorded. Data was then analyzed to determine if dilatation improved dysphagia.FigureTable: Table. Patients with IEM who had one EGD with dilationTable: Table. Patients with IEM who had multiple EGD with dilationResults: 28% underwent EGD with dilation. 73% were female mean age was 53 see. figure and table. Conclusion: This data suggests that esophageal dilation may, at least temporarily, help relieve dysphagia in about 40% of patients with IEM. Unfortunately, half of those had recurrence of dysphagia within a few months. Further studies are needed to better define the role of esophageal dilation in this population.

Control of inflammation decreases the need for subsequent esophageal dilation in patients with eosinophilic esophagitis.

It is unknown if successful control of esophageal inflammation in eosinophilic esophagitis (EoE) decreases the need for subsequent esophageal dilation. We aimed to determine whether histologic response to topical steroid treatment decreases the likelihood and frequency of subsequent esophageal dilation. We conducted a retrospective cohort study. Patients with an incident diagnosis of EoE were included if they had an initial esophageal dilation, received topical steroids, and had a subsequent endoscopy with biopsies. The number of dilations performed in each group was determined, and histologic responders (<15 eos/hpf) were compared to nonresponders. The 55 EoE patients included (27 responders and 28 nonresponders) underwent a mean of 3.0 dilations over a median follow-up of 19 months. Responders required fewer dilations than nonresponders (1.6 vs. 4.6, P = 0.03), after adjusting for potential confounders. Despite undergoing significantly fewer dilations, responders achieved a similar increase in esophageal diameter with dilation (4.9 vs. 5.0 mm; P = 0.92). In EoE patients undergoing esophageal dilation at baseline, control of inflammation with topical steroids was associated with a 65% decrease in the number of subsequent dilations to maintain the same esophageal caliber. This suggests that inflammation control is an important goal in patients with fibrostenotic changes of EoE.

Role of endoscopic esophageal dilation in managing eosinophilic esophagitis: A systematic review and meta-analysis.

Background:Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disorder of the esophagus characterized by mucosal eosinophilic infiltration. Topical glucocorticoids are considered standard line of treatment, whereas endoscopic dilations are performed for patients presenting with treatment-resistant disease or manifestations of dysphagia and/or food impactions. Efficacy and safety of esophageal dilation in these patients are currently unclear.Aims:Primary outcomes were to evaluate the efficacy, adverse events, and mortality rates of endoscopic esophageal dilation in patients with EoE.Methods: Study Selection Criteria:Studies that reported the use of esophageal dilation in EoE patients were included in this meta-analysis.Data collection and extraction:Articles were searched in Medline, Pubmed, and Ovid journals. Two authors independently searched and extracted data. The study design was written in accordance to PRISMA statement. Clinical improvement was defined as patient-reported symptom relief noted by the authors of individual studies. The symptoms were assessed on various nonstandardized, however, relevant questionnaires that were deemed appropriate by the senior authors of individual studies.Statistical Method:Pooled proportions were calculated using fixed- and random-effects model. I2 statistic was used to assess heterogeneity among studies.Results:Initial search identified 491 reference articles, in which 39 articles were selected and reviewed. Data were extracted from 14 studies (N = 1607) using esophageal dilation for EoE management, which met the inclusion criterion. Mean age of patients was 41years. Pooled patients included 75% males. The pooled proportion of patients that showed clinical improvement with esophageal dilations, after the median follow-up period of 12 months, was 84.95%. No procedure-related deaths were noted. The pooled proportion of patients with post procedural esophageal perforation, chest pain, hospitalization, deep mucosal tear (involving muscularis propria), small mucosal tear, and hemorrhage were 0.61%, 0.06%, 0.74%, 4.04%, 22.32%, and 0.38% respectively. I2 (inconsistency) was 0% (95% confidence interval [CI] = 0–49.8) and Egger: bias was 0.06 (95% CI = −0.30 to 0.42).Conclusions:In patients with conformed diagnosis of EoE, endoscopic esophageal dilation seems to be an effective and safe treatment option. Majority patients with chest pain and deep mucosal tears did not require hospitalization and symptoms were self-limiting

Mo1187 Control of Inflammation With Topical Steroids Decreases Need for Subsequent Esophageal Dilation in Patients With Eosinophilic Esophagitis

Mo1187 Control of Inflammation With Topical Steroids Decreases Need for Subsequent Esophageal Dilation in Patients With Eosinophilic Esophagitis

Randomized controlled trial comparing esophageal dilation to no dilation among adults with esophageal eosinophilia and dysphagia.

The role of esophageal dilation in patients with esophageal eosinophilia with dysphagia remains unknown. The practice of dilation is currently based on center preferences and expert opinion. The aim of this study is to determine if, and to what extent, dysphagia improves in response to initial esophageal dilation followed by standard medical therapies. We conducted a randomized, blinded, controlled trial evaluating adult patients with dysphagia and newly diagnosed esophageal eosinophilia from 2008 to 2013. Patients were randomized to dilation or no dilation at time of endoscopy and blinded to dilation status. Endoscopic features were graded as major and minor. Subsequent to randomization and endoscopy, all patients received fluticasone and dexlansoprazole for 2 months. The primary study outcome was reduction in overall dysphagia score, assessed at 30 and 60 days post-intervention. Patients with severe strictures (less than 7-mm esophageal diameter) were excluded from the study. Thirty-one patients were randomized and completed the protocol: 17 randomized to dilation and 14 to no dilation. Both groups were similar with regard to gender, age, eosinophil density, endoscopic score, and baseline dysphagia score. The population exhibited moderate to severe dysphagia and moderate esophageal stricturing at baseline. Overall, there was a significant (P < 0.001) but similar reduction in mean dysphagia score at 30 and 60 days post-randomization compared with baseline in both groups. No significant difference in dysphagia scores between treatment groups after 30 (P = 0.93) or 60 (P = 0.21) days post-intervention was observed. Esophageal dilation did not result in additional improvement in dysphagia score compared with treatment with proton pump inhibitor and fluticasone alone. In patients with symptomatic esophageal eosinophilia without severe stricture, dilation does not appear to be a necessary initial treatment strategy.

Clinical Presentation Doesn’t Predict the Need for Esophageal Dilation in Patients with Eosinophilic Esophagitis

Clinical Presentation Doesn’t Predict the Need for Esophageal Dilation in Patients with Eosinophilic Esophagitis

The role of endoscopy in the evaluation and management of dysphagia

The role of endoscopy in the evaluation and management of dysphagia

Comparison of idiopathic achalasia and Chagas' disease esophagopathy at the light of high-resolution manometry

The comparison between idiopathic achalasia (IA) and Chagas' disease esophagopathy (CDE) may evaluate if treatment options and their outcomes can be accepted universally. This study aims to compare IA and CDE at the light of high-resolution manometry. We studied 86 patients with achalasia: 45 patients with CDE (54% females, mean age 55 years) and 41 patients with IA (58% females, mean age 49 years). All patients underwent high-resolution manometry. Upper esophageal sphincter parameters were similar (basal pressure CDE = 72 ± 45 mmHg, IA = 82 ± 57 mmHg; residual pressure CDE = 9.9 ± 9.9 mmHg, IA = 9.8 ± 7.5 mmHg). In the body of the esophagus, the amplitude was higher in the IA group than the CDE group at 3 cm (CDE = 15 ± 14 mm Hg, IA = 42 ± 52 mmHg, P = 0.003) and 7 cm (CDE = 16 ± 15 mmHg, IA = 36 ± 57 mmHg, P = 0.04) above the lower esophageal sphincter (LES). The LES basal pressure (CDE = 17 ± 16 mmHg, IA = 40 ± 22 mmHg, P < 0.001) and residual pressure (CDE = 12 ± 11 mmHg, IA = 27 ± 13 mmHg, P < 0.001) were also higher in the IA group. Our results show that: (i) there is no difference in regards to the upper esophageal sphincter; (ii) higher pressures of the esophageal body are noticed in patients with IA; and (iii) basal and residual pressures of the LES are lower in patients with CDE. Our results did not show expressive manometric differences between IA and CDE. Some differences may be attributed to a more pronounced esophageal dilatation in patients with CDE.

AB0502 Long-term follow-up of esophageal diameter in patients with anti-centromere antibody sero-positive systemic sclerosis and primary sjögren’s syndrome

BackgroundAnti-centromere antibodies (ACA) are characteristic autoantibodies which are detected in patients with systemic sclerosis (SSc) and primary Sjögren’s syndrome (pSS). We previously reported that ACA are a useful marker of...

Esophageal Distensibility as a Measure of Disease Severity in Patients With Eosinophilic Esophagitis

The aim of this study was to assess whether measurements of esophageal distensibility, made by high-resolution impedance planimetry, correlated with important clinical outcomes in patients with eosinophilic esophagitis. Seventy patients with eosinophilic esophagitis (50 men; age, 18-68 y) underwent endoscopy with esophageal biopsy collection and high-resolution impedance planimetry using the functional lumen-imaging probe. The patients were followed up prospectively for an average of 9.2 months (range, 3-14 mo), and the risk of food impaction, requirement for dilation, and symptom severity during the follow-up period was determined from medical records. Esophageal distensibility metrics and the severity of mucosal eosinophilia at baseline were compared between patients presenting with and without food impaction and those requiring or not requiring esophageal dilation. Logistic regression and stratification assessments were used to assess the predictive value of esophageal distensibility metrics in assessing risk of food impaction, the need for dilation, and continued symptoms. Patients with prior food impactions had significantly lower distensibility plateau (DP) values than those with solid food dysphagia alone. In addition, patients sustaining food impaction and requiring esophageal dilation during the follow-up period had significantly lower DP values than those who did not. The severity of mucosal eosinophilia did not correlate with risk for food impaction, the requirement for dilation during follow-up evaluation, or DP values. Reduced esophageal distensibility predicts risk for food impaction and the requirement for esophageal dilation in patients with eosinophilic esophagitis. The severity of mucosal eosinophilia was not predictive of these outcomes and had a poor correlation with esophageal distensibility.

Effect of Oral Fluticasone on Refractory Peptic Esophageal Stricture - A New Therapeutic Method for Refractory Peptic Esophageal Stricture

Purpose: Esophageal dilation is a safe and effective initial therapeutic option for the treatment of benign strictures of the esophagus. Intralesional steroid therapy, electrosurgical incision, or stent placement can be used for specific patients with refractory benign esophageal stricture. However, in some patients with refractory esophageal stricture, these therapeutic modalities may not be effective. The purpose of this study is to evaluate oral fluticasone inhaler as a therapeutic modality for management of refractory peptic esophageal stricture. Methods: Patients with refractory peptic esophageal stricture (after eosinophilic esophagitis were ruled out) were enrolled in this study. As EGD with intralesional steroid injection must be performed at intervals, we prescribed patients oral inhalation therapy with fluticasone for use between dilations and compared its effect with that of intralesional steroid injection on frequency of esophageal dilation. To avoid any possible bias, oral steroid inhaler was given alternatively at each session of esophageal dilation and intralesional steroid injection, as showed in this flow diagram: A__B__A__B__A__B__A___B__. (A: esophageal dilation + intralesional lesion steroid injection; B: esophageal dilation + intralesional lesion steroid injection + oral steroid inhaler). We analyzed the data from the first 6 sessions. Results: With dilation only, patients required subsequent dilation about once a month. When intralesional steroid injection was performed in addition to dilation, patients required dilations about every 2 months. Use of inhaled oral steroids significantly decreased the frequency of esophageal dilations (see Table). There were no side effects with the use of fluticasone during this period.Table: [54] Days elapsed between esophageal dilationsConclusion: Oral steroid inhaler therapy is more effective than intralesional steroid injection in augmenting the effect of esophageal dilation in patients with refractory peptic esophageal stricture. To our knowledge, this is the first report of using orally inhaled steroid in treatment of refractory peptic esophageal stricture. A multiple center study is needed to investigate this novel observation further.

A novel balloon pull-through technique for esophageal dilation in eosinophilic esophagitis (with video)

Eosinophilic esophagitis (EoE) is a chronic inflammatory condition that can be complicated by esophageal strictures requiring endoscopic dilation. Whereas recent data have advanced the notion that dilation can be done effectively with minimal morbidity, issues concerning safety and tolerability remain. To review our initial experience with a novel esophageal balloon pull-through technique for sizing and dilation in EoE as well as to present a video illustrating the methodology. Case series. Tertiary-care referral center. Thirteen patients with EoE. Balloon pull-through technique for esophageal dilation. Dilation effect, size, and complications (esophageal perforation, bleeding requiring endoscopic hemostasis, or severe chest pain requiring hospitalization). Thirteen patients (7 men, 6 women; mean age 40 years, range 19-66 years) with EoE underwent dilation with the esophageal balloon pull-through technique. Resistance during the pull-through was encountered in 11 patients (85%), even though no discrete areas of narrowing were encountered. A tear was achieved in 9 patients (69%). Nine patients (69%) reported improvement in their dysphagia after dilation. There were no serious complications from the procedure. Retrospective, single center, small patient numbers in this initial report. The esophageal balloon pull-through technique for esophageal dilation in patients with EoE appears to be safe and effective. It is a rational approach to gauging the luminal diameter of the esophagus and treating strictures in patients with EoE and dysphagia, but further prospective study is required to confirm these initial results.

Occurrence of and risk factors for complications after endoscopic dilation in eosinophilic esophagitis

Several small series have suggested an increased risk of complications associated with esophageal dilation in patients with eosinophilic esophagitis (EoE). To quantitate the risk and identify risk factors for esophageal complications in dilation in EoE patients. Retrospective, uncontrolled, single-center study. Tertiary referral hospital. A total of 161 EoE patients (mean ± standard deviation age 44.3 ± 15.3 years, 112 men, 49 women, 150 white patients, 10 unknown, 1 Asian). Through-the-scope balloon or Savary dilation of EoE. The rate of complications defined as deep mucosal tear, major bleeding, or perforation, and determination of risk factors for complications. A total of 293 dilations were performed in 161 patients. Complications reported were deep mucosal tear in 9.2% (n = 27), major bleeding in 0.3% (n = 1), and immediate perforation in 1.0% (n = 3). All patients with perforations were successfully treated medically without surgery (mean ± standard deviation hospital stay 5.3 ± 3.2 days). Factors associated with an increased risk of complications were luminal narrowing in the upper (odds ratio [OR], 5.62; 95% CI, 2.07-15.26; P < .001) and middle third of the esophagus (OR, 4.93; 95% CI, 1.64-14.83; P < .005) compared with lower third, luminal stricture unable to be traversed with a standard upper endoscope (OR, 2.48; 95% CI, 1.06-5.83; P = .037), and use of Savary dilator (OR, 2.63; 95% CI, 1.18-5.83; P = .018). Retrospective design, uncontrolled study. Deep mucosal tears are common after dilation (9%), but the risk of immediate transluminal perforation with EoE is approximately 1%. The risk of severe complications is increased in patients with more proximal stricture and strictures that initially prevent endoscope passage.

W1870 Long Term Outcome of Esophageal Dilation in Patients with Diffuse Esophageal Spasm

W1870 Long Term Outcome of Esophageal Dilation in Patients with Diffuse Esophageal Spasm

Critical Evaluation of Esophageal Dilation in Nonobstructive Dysphagia With and Without Esophageal Rings

To evaluate the therapeutic efficacy of esophageal dilation compared with medical treatment in patients with nonobstructive dysphagia (NOD). Clinical studies evaluating the role of esophageal dilation in patients with NOD have reported conflicting results. In addition, studies suggesting beneficial effects of esophageal dilation in this group of patients have not compared it with medical treatment. We conducted a retrospective study in 107 patients with NOD and divided these patients into 2 groups. Group 1 included patients who received esophageal dilation with a polyvinyl bougie along with adjunctive medical treatment, and group 2 included patients who received medical treatment alone. Complete resolution of symptoms occurred in 41 of the 60 patients (68.3%) who received esophageal dilation. In the group that received medical treatment alone (n=47), 28 patients (59.5%) had complete resolution of symptoms. There was no statistically significant difference in symptom resolution between the 2 groups. In addition, among 22 patients with esophageal rings, 17 patients (77%) had complete symptomatic relief with dilation, as compared with 63% patients without esophageal rings. Although there was a trend towards higher frequency of dysphagia resolution with esophageal dilation in patients with NOD and esophageal rings, the difference failed to reach statistical significance. Esophageal dilation and medical therapy are equally efficacious (60% to 70% of cases) in resolving symptoms of dysphagia in patients with NOD. Patients with NOD and esophageal rings may represent the subgroup of patients who are more likely to benefit from esophageal dilation.