The complications of Botox treatment are reflux in a small percentage, rare flu-like symptoms, and the risks of endoscopy. The amount of botulinum toxin injected is not enough to cause paralysis elsewhere in the body. These may occur at any level of the esophagus and typically cause difficulty swallowing . When these occur in the upper esophagus, they may be associated with other diseases such as iron deficiency anemia or graft versus host disease. Some authors believe that webs that arise in the mid to distal esophagus may be related to reflux .
Rings differ from webs primarily by being thicker and involving more of the wall of the esophagus.
This ring in the distal esophagus is felt to be related to reflux. The primary symptom of a Schatzki's ring is an intermittent problem of food sticking. Rings and webs are best detected by barium studies although endoscopy may also show these. Treatment of both rings and webs is by dilatation, usually performed with one large dilator. Afterwards, patients may be placed on antireflux medications to try to prevent recurrence.