IS Case 210: Schatzki ring

Lisa Siripun, MD

Imaging Sciences URMC 2008
Publication Date: 2009-05-22

History

Patient is a 53-year-old male with history of dysphagia.

Diagnosis

Discussion

Schatzki ring is an annular narrowing of the lower esophagus or B ring. It is quite common and may be found in as many as 15% of all patients undergoing barium swallow studies; however, few of these patients exhibit symptoms of dysphagia. The episode of dysphagia appears to be short lived after swallowing a bolus of food, with the food transiently impacted at the ring. Most patients are older than 40 years at presentation. The pathogenesis of Schatzki rings is not clear.

Fluoroscopic contrast barium study of our patient shows a thin, fixed transverse ring with constant shape at GE junction with associated hiatal hernia. The Schatzki ring is best visualized when the lumen above and below is distended beyond the caliber of the ring; adequate distension may require prone positioning during arrested deep inspiration with valsava maneuver when the barium column passes through GE junction. It is important to differentiated sliding hiatal hernia from the phrenic ampulla of the distal esophagus, a normal variant.

Complications of Schatzki ring include peptic stricture with long standing reflux, perforation, and bleeding.

Treatments include esophageal dilatation and antireflux surgery. Surgical excision maybe required.

References

Vasudeva R. Schatzki ring. eMedicine, April 18, 2006. http://emedicine.medscape.com/article/182647-overview
Ott DJ, Gelfand DW, Wu WC, Castell DO. Esophagogastric region and its rings. AJR Am J Roentgenol. 1984 Feb;142(2):281-7. [PMID: 6364745]
Luedtke P, Levine MS, Rubesin SE, Weinstein DS, Laufer I. Radiologic diagnosis of benign esophageal strictures: a pattern approach. Radiographics. 2003 Jul-Aug;23(4):897-909. [PMID: 12853664]