Schatzki ring
A Schatzki ring, also called Schatzki-Gary ring, is symptomatically narrow esophageal B-ring occurring in the distal esophagus and usually associated with a hiatus hernia.
Epidemiology
Relatively common, lower esophageal rings are found in ~10% of oesophagrams.
Clinical presentation
Most commonly it 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, an esophageal B-ring may be symptomatic or asymptomatic :
- <13 mm: almost always symptomatic
- 13-20 mm: sometimes symptomatic
- >20 mm: rarely symptomatic
When it is symptomatic, it is termed a "Schatzki ring".
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 to the B-ring
- esophageal webs, which are lined on both sides by esophageal mucosa
Associations
More than half of patients will have an associated esophageal condition such as :
- hiatus hernia
- reflux esophagitis
- esophageal web
- esophageal diverticulum
Radiographic features
Fluoroscopy: barium swallow
Single-contrast solid barium swallows (especially in the RAO prone position) are more sensitive than endoscopy in detecting Schatzki rings . On barium swallow the following features may be seen :
- full-column barium swallow will reveal a circumferential narrowing at the gastro-esophageal junction, often a few centimeters above the diaphragmatic hiatus
- thin smooth ring, 1-3 mm
- 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) .
Differential diagnosis
On fluoroscopy consider
- esophageal A-ring
- esophageal web
- esophageal stricture: longer, with tapered ends
- distal esophageal carcinoma: usually irregular in appearance
Siehe auch:
Assoziationen und Differentialdiagnosen zu Schatzki-Ring:
