Revision 21 for 'Schatzki ring'

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Schatzki ring

Schatzki rings (also called Schatzki-Gary rings or B-rings) are a mucosal ring in the distal esophagus that may be related to dysphagia. It is relatively common and tends to occur at the squamocolumnar junction. Depending on its luminal diameter, may be symptomatic or asymptomatic.

Epidemiology

Relatively common, found on ~10% of barium swallows. 

Clinical presentation

Most commonly presents as intermittent dysphagia, especially to solid food. A history of food impaction is also very common. Dysphagia is more common in patients with an associated motility disorder. 

Pathology

The pathogenesis of the Schatzki ring is unclear with conflicting hypotheses that include redundant pleats of mucosa, congenital abnormalities and modified peptic strictures. Interestingly, there is a reduced incidence of Barrett's esophagus in patients with a Schatzki ring.

Location

Schatzki rings are located a few centimeters above the gastro-esophageal junction (GEJ) and is not to be confused with an esophageal A-ring, which occurs at the GEJ.

Associations

More than half of patients will have an associated esophageal condition such as 2:

Radiographic features

Fluoroscopy

Single-contrast solid barium swallows are more sensitive than endoscopy in detecting Schatzki rings 3. On barium swallow the following features may be seen 1:

  • full-column barium swallow will reveal a circumferential narrowing 3-4 cm above the GEJ
  • double contrast studies are less sensitive
  • performing a Valsalva manouver may improve sensitivity
  • barium-tablet or barium-coated marshmallow may also improve sensitivity

History and etymology

Named after Richard Schatzki (1901-92), American physician (born in Germany) 1.

Differential diagnosis

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