Schatzki Ring Workup

  • Author: Rajeev Vasudeva, MD, FACG; Chief Editor: Julian Katz, MD   more...
 
Updated: Jan 2, 2010
 

Imaging Studies

  • Barium esophagram
    • Perform a prone full-column barium esophagram as the initial study because it is more sensitive than double-contrast radiography or endoscopy, especially when the luminal diameter is more than 10 mm. (See the following 2 images)Endoscopic appearance of the distal esophagus illuEndoscopic appearance of the distal esophagus illustrating a Schatzki ring. Barium swallow illustrating an indentation at the Barium swallow illustrating an indentation at the gastroesophageal junction consistent with a Schatzki ring above a sliding hiatal hernia.
    • Distending the lower esophagus by performing the Valsalva maneuver enhances sensitivity.
    • The sensitivity may be further improved by using a barium tablet or a coated marshmallow.
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Procedures

  • Esophagogastroduodenoscopy
    • Although barium studies are performed initially, esophagogastroduodenoscopy is performed subsequently to confirm the diagnosis and to exclude any other diagnosis.
    • Endoscopic examination evaluates the mucosa of the distal esophagus, confirming the diagnosis of concomitant gastroesophageal reflux disease or a short peptic stricture instead of a ring.
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Histologic Findings

The upper surface of a Schatzki ring is covered by squamous epithelium, and the lower surface is covered by columnar epithelium because the ring is usually located at the squamocolumnar junction. The ring is composed of the mucosa and submucosa and does not contain the muscularis propria. Occasionally, the lamina propria may contain fibrous tissue.

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Contributor Information and Disclosures
Author

Rajeev Vasudeva, MD, FACG  Clinical Professor of Medicine, Consultants in Gastroenterology, University of South Carolina School of Medicine

Rajeev Vasudeva, MD, FACG is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, Columbia Medical Society, South Carolina Gastroenterology Association, and South Carolina Medical Association

Disclosure: Pricara Honoraria Speaking and teaching; UCB Consulting fee Consulting

Specialty Editor Board

Mounzer Al Al Samman, MD  Department of Internal Medicine, Division of Gastroenterology, Assistant Professor, Texas Tech University School of Medicine

Mounzer Al Al Samman, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, and American Gastroenterological Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Noel Williams, MD  Professor Emeritus, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Professor, Department of Internal Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada

Noel Williams, MD is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Alex J Mechaber, MD, FACP  Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

References

  1. Ingelfinger FJ, Kramer P. Dysphagia produced by a contractile ring in the lower esophagus. Gastroenterology. 1953;23:419-430.

  2. Schatzki R, Gary JE. Dysphagia due to a diaphragm-like localized narrowing in the lower esophagus ("lower esophageal ring"). Am J Roentgenol. 1953;70:911-922.

  3. Goyal RK, Spiro HM. Lower esophageal ring. N Engl J Med. Sep 3 1970;283(10):541. [Medline].

  4. Goyal RK, Glancy JJ, Spiro HM. Lower esophageal ring. 1. N Engl J Med. Jun 4 1970;282(23):1298-305. [Medline].

  5. Goyal RK, Glancy JJ, Spiro HM. Lower esophageal ring. 2. N Engl J Med. Jun 11 1970;282(24):1355-62. [Medline].

  6. Goyal RK, Bauer JL, Spiro HM. The nature and location of lower esophageal ring. N Engl J Med. May 27 1971;284(21):1175-80. [Medline].

  7. Rees CJ, Fordham T, Belafsky PC. Transnasal balloon dilation of the esophagus. Arch Otolaryngol Head Neck Surg. Aug 2009;135(8):781-3. [Medline].

  8. Wills JC, Hilden K, Disario JA, Fang JC. A randomized, prospective trial of electrosurgical incision followed by rabeprazole versus bougie dilation followed by rabeprazole of symptomatic esophageal (Schatzki's) rings. Gastrointest Endosc. May 2008;67(6):808-13. [Medline].

  9. American Society for Gastrointestinal Endoscopy. Antibiotic prophylaxis for gastrointestinal endoscopy. American Society for Gastrointestinal Endoscopy. Gastrointest Endosc. Dec 1995;42(6):630-5. [Medline].

  10. Burdick JS, Venu RP, Hogan WJ. Cutting the defiant lower esophageal ring. Gastrointest Endosc. Sep-Oct 1993;39(5):616-9. [Medline].

  11. Chen YM, Gelfand DW, Ott DJ. Natural progression of the lower esophageal mucosal ring. Gastrointest Radiol. 1987;12(2):93-8. [Medline].

  12. Chotiprasidhi P, Minocha A. Effectiveness of single dilation with Maloney dilator versus endoscopic rupture of Schatzki''s ring using biopsy forceps. Dig Dis Sci. Feb 2000;45(2):281-4. [Medline].

  13. DeVault KR. Lower esophageal (Schatzki''s) ring: pathogenesis, diagnosis and therapy. Dig Dis. Sep-Oct 1996;14(5):323-9. [Medline].

  14. Eckardt VF, Kanzler G, Willems D. Single dilation of symptomatic Schatzki rings. A prospective evaluation of its effectiveness. Dig Dis Sci. Apr 1992;37(4):577-82. [Medline].

  15. Groskreutz JL, Kim CH. Schatzki''s ring: long-term results following dilation. Gastrointest Endosc. Sep-Oct 1990;36(5):479-81. [Medline].

  16. Guelrud M, Villasmil L, Mendez R. Late results in patients with Schatzki ring treated by endoscopic electrosurgical incision of the ring. Gastrointest Endosc. Apr 1987;33(2):96-8. [Medline].

  17. Hendrix TR. Schatzki ring, epithelial junction, and hiatal hernia--an unresolved controversy. Gastroenterology. Sep 1980;79(3):584-5. [Medline].

  18. Ibrahim A, Cole RA, Qureshi WA. Schatzki''s ring: to cut or break an unresolved problem. Dig Dis Sci. Mar 2004;49(3):379-83. [Medline].

  19. Jamieson J, Hinder RA, DeMeester TR. Analysis of thirty-two patients with Schatzki''s ring. Am J Surg. Dec 1989;158(6):563-6. [Medline].

  20. Johnson AC, Lester PD, Johnson S. Esophagogastric ring: why and when we see it, and what it implies: a radiologic-pathologic correlation. South Med J. Oct 1992;85(10):946-52. [Medline].

  21. Marshall JB, Kretschmar JM, Diaz-Arias AA. Gastroesophageal reflux as a pathogenic factor in the development of symptomatic lower esophageal rings. Arch Intern Med. Aug 1990;150(8):1669-72. [Medline].

  22. Mossberg SM. Lower esophageal ring treated by pneumatic dilatation. Gastroenterology. 1965;48:118-121.

  23. Ott DJ. Radiographic techniques and efficacy in evaluating esophageal dysphagia. Dysphagia. 1990;5(4):192-203. [Medline].

  24. Ott DJ, Chen YM, Wu WC. Radiographic and endoscopic sensitivity in detecting lower esophageal mucosal ring. AJR Am J Roentgenol. Aug 1986;147(2):261-5. [Medline].

  25. Ott DJ, Gelfand DW, Lane TG. Radiologic detection and spectrum of appearances of peptic esophageal strictures. J Clin Gastroenterol. Feb 1982;4(1):11-5. [Medline].

  26. Ott DJ, Gelfand DW, Wu WC. Radiological evaluation of dysphagia. JAMA. Nov 21 1986;256(19):2718-21. [Medline].

  27. Schatzki R. The lower esophageal ring. Long term follow up of symptomatic and asymptomatic cases. Am J Roentgenol. 1963;90:805-810.

  28. [Best Evidence] Sgouros SN, Vlachogiannakos J, Karamanolis G. Long-term acid suppressive therapy may prevent the relapse of lower esophageal (Schatzki's) rings: a prospective, randomized, placebo-controlled study. Am J Gastroenterol. Sep 2005;100(9):1929-34. [Medline].

  29. Spechler SJ. AGA technical review on treatment of patients with dysphagia caused by benign disorders of the distal esophagus. Gastroenterology. Jul 1999;117(1):233-54. [Medline].

  30. Spechler SJ. American gastroenterological association medical position statement on treatment of patients with dysphagia caused by benign disorders of the distal esophagus. Gastroenterology. Jul 1999;117(1):229-33. [Medline].

  31. Winters GR, Maydonovitch CL, Wong RK. Schatzki''s rings do not protect against acid reflux and may decrease esophageal acid clearance. Dig Dis Sci. Feb 2003;48(2):299-302. [Medline].

  32. Wu WC. Esophageal rings and webs. In: Castell DO, ed. The Esophagus. 2nd ed. 1995:337-343.

 
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Endoscopic appearance of the distal esophagus illustrating a Schatzki ring.
Barium swallow illustrating an indentation at the gastroesophageal junction consistent with a Schatzki ring above a sliding hiatal hernia.
A Schatzki ring dilated by the passage of a single large bougie.
 
 
 
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