From the Guidelines
A patulous esophagus is an incidental finding that does not require specific treatment, and management should focus on the underlying condition if symptoms are present. The most common causes of a patulous esophagus include aging, GERD (gastroesophageal reflux disease), scleroderma, achalasia, or other motility disorders 1. If a patient has symptoms like dysphagia (difficulty swallowing), regurgitation, or heartburn, treatment should focus on the underlying condition rather than the patulous appearance. For example, if GERD is present, treatment with proton pump inhibitors such as omeprazole 20-40mg daily or pantoprazole 40mg daily would be appropriate, as standard dose proton pump inhibitor treatment is clearly more effective than H2 receptor antagonists 1.
Key Considerations
- The patulous appearance occurs because the normal muscular tone of the esophagus is compromised, allowing the esophageal lumen to remain open rather than collapsed when empty 1.
- This finding alone doesn't necessarily indicate pathology but should prompt evaluation for underlying esophageal disorders if the patient is symptomatic 1.
- Oesophageal dilatation is indicated in the treatment of symptomatic narrowing of the oesophagus, which may develop from a wide range of anatomical and functional oesophageal disorders 1.
- The primary aim of oesophageal dilatation is to alleviate symptoms, permit maintenance of oral nutrition and reduce the risk of pulmonary aspiration 1.
Treatment Approach
- Offer dilatation as first-line treatment in patients with acute symptoms such as food bolus obstruction and daily dysphagia (GRADE of evidence: moderate; strength of recommendation: strong) 1.
- Consider preliminary medical treatment and diet elimination for EoE: PPI, diet and topical steroids are all used as first-line treatments (in up to 50%) 1.
- Start other treatments for EoE before dilatation if possible, and those may be continued afterwards to prevent or delay recurrence of symptoms (GRADE of evidence: moderate; strength of recommendation: strong) 1.
From the Research
Definition and Prevalence of Patulous Esophagus
- A patulous esophagus refers to a condition where the upper esophageal sphincter (UES) is abnormally open or relaxed, potentially leading to symptoms such as dysphagia 2.
- The prevalence of patulous esophagus is not well-established, but it is considered a rare condition 2.
Relationship with Gastroesophageal Reflux Disease (GERD)
- Patulous esophagus may be associated with GERD, as both conditions involve abnormalities in the functioning of the esophagus 3, 4.
- Studies have shown that persistent GERD symptoms despite proton pump inhibitor (PPI) treatment are common, and alternative approaches to management may be required 3.
Diagnosis and Treatment
- Diagnosis of patulous esophagus can be made through endoscopy, and endoscopists should be aware of this rare condition when evaluating patients with oropharyngeal dysphagia 2.
- Treatment options for patulous esophagus are not well-established, but may involve surgical or endoscopic interventions 4.
- PPIs may be used to treat GERD symptoms, but the long-term use of PPIs should be carefully evaluated to minimize potential risks 5, 6.