Schatzki ring

Background

Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.

Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.

Esophagus anatomy and nomenclature based on two systems.

Schatzki ring at lower esophageal sphincter, one of four areas of natural narrowing.

• Impacted food bolus common ED complaint
• 4 areas of narrowing in the esophagus
  • Upper esophageal sphincter (cricopharyngeus muscle)
  • Aortic arch
  • L mainstem bronchus
  • Lower esophageal sphincter
• Schatzki Ring: mucosal or muscular tissue ring

Clinical Features

• Dysphagia with solid foods
• Food sticking sensation with swallowing
• Crushing chest pain with complete bolus obstruction
  • "Steakhouse syndrome"

Differential Diagnosis

Dysphagia

• Oropharyngeal dysphagia
  • CVA
  • Parkinson's disease
  • Brain stem tumors
  • Degenerative disease - ALS, MS, Huntington's
  • Postinfectious - polio, syphilis
  • Peripheral neuropathy
  • Myasthenia gravis
  • Polymyositis, dermatomyositis
  • Muscular dystrophy
• Esophageal dysphagia
  • Achalasia
  • Diffuse esophageal spasm
  • Ingested foreign body
  • Esophageal web
  • Malignancy, mediastinal masses
  • Schatzki Ring
  • Scleroderma
  • Strictures - peptic, radiation, chemical, medication-induced
  • Vascular compression
  • Zenker's diverticulum

Evaluation

Barium swallow with narrowing at ring

• EGD
  • Esophageal webs do not completely encircle the esophagus
• Barium swallow

Management

• No treatment for asymptomatic
• Food bolus removed with endoscopy
• Balloon dilation of symptomatic rings

See Also

Dysphagia