Revision 31 for 'Schatzki ring'

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Schatzki ring

Schatzki rings (also called Schatzki-Gary rings or B-rings) are a type of lower esophageal rings along with A-rings

Epidemiology

Relatively common, lower esophageal rings are 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 esophagus in patients with a Schatzki ring.

Depending on its luminal diameter, Schatzki rings may be symptomatic or asymptomatic 4:

  • <13 mm: almost always symptomatic
  • 13-20 mm: sometimes symptomatic
  • >20 mm: rarely symptomatic
Location

Schatzki rings are located at the gastro-esophageal junction, illustrated by the fact that there is squamous epithelium above and columnar epithelial below the ring. They should not be confused with A-rings, which are found a few centimeters proximal and esophageal webs, which are lined on both sides by esophageal mucosa 6-8

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 at the gastro-esophageal junction, often a few centimeters above the diaphragmatic hiatus
  • double contrast studies are less sensitive
  • performing a Valsalva maneuver may improve sensitivity
  • barium-tablet or barium-coated marshmallow may also improve sensitivity

History and etymology

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

Differential diagnosis

On fluoroscopy consider

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