The Lower Oesophageal Ring

SUMMARYAll of the radiographs of lower oesophageal rings collected personally during the last three years have been studied. It is proposed that any annular narrowing of the lower oesophagus which can be identified as the inferior oesophageal sphincter should not be classified as a lower oesophageal ring. Of the various hypotheses concerning the nature of the ring, the plication theory which postulates the formation of an accordeon‐like pleat or fold, whether at or above the squamo‐columnar junction, is the most attractive. Such a fold indicates abnormal laxity and abnormal sliding in a caudo‐cranial axis, which is a sign of hiatal herniation.In 500 consecutive barium meals hiatal hernia was diagnosed in 31%. As a sign of hiatal hernia, a lower oesophageal ring was the basis of the diagnosis in one‐tenth of these. The incidence of lower oesophageal rings in the entire series of 500 was 3%. No rings or hernias were found in 40 medical student controls.