| Schatzki ring | |
|---|---|
 | |
| Endoscopic image ofSchatzki ring, seen in theesophagus with thegastro-esophageal junction in the background. | |
| Specialty | Medical genetics  |
ASchatzki ring orSchatzki–Gary ring is a narrowing of the loweresophagus that can cause difficulty swallowing (dysphagia). The narrowing is caused by a ring ofmucosal tissue (which lines the esophagus) or muscular tissue.[1] A Schatzki ring is a specific type of "esophageal ring", and Schatzki rings are further subdivided into those above theesophagus/stomach junction (A rings),[2] and those found at the squamocolumnar junction in the lower esophagus (B rings).[2][3]
Patients with Schatzki rings can develop intermittentdifficulty swallowing or, more seriously, a completely blocked esophagus. The ring is named after the German-American physicianRichard Schatzki.
Not all patients with Schatzki rings have symptoms;barium swallow tests of the esophagus sometimes show Schatzki rings in patients with no swallowing difficulties.[citation needed]
When Schatzki rings cause symptoms, they usually result in episodic difficulties with swallowing (dysphagia) solid foods, or a sensation that the food "sticks" while swallowing, especially if the food is not chewed thoroughly. Patients usually are able toregurgitate or force through the food material and resume eating. However, complete obstruction of the esophagus by abolus of food (often calledsteakhouse syndrome) can occur. This can cause crushingchest pain and may need immediate treatment withendoscopy, which is the use of a specializedfibre-optic camera in order to remove the lodged food.[4] After the obstruction is located, snares orforceps are inserted to pull the food out of the esophagus or to push it into thestomach. The latter is done with caution, usually when the anatomy of the structures around the obstruction is already known.[citation needed]
Although many hypotheses have been proffered, the cause of Schatzki rings remains uncertain; bothcongenital and acquired factors may be involved.[citation needed]
A Schatzki ring is usually diagnosed byesophagogastroduodenoscopy orbarium swallow. Endoscopy usually shows a ring within thelumen of the esophagus which can be of variable size (see picture). The ring is usually located a few centimetres above thegastro-esophageal junction, where the esophagus joins the stomach. Schatzki rings can often resemble a related entity called anesophageal web. Esophageal webs also contain extra mucosal tissue, but do not completely encircle the esophagus.[citation needed]
Endoscopies and barium swallows done for other reasons often reveal unsuspected Schatzki rings,[7] meaning that many Schatzki rings are asymptomatic.[citation needed]
Two varieties of Schatzki rings have been described. The original description by Schatzki and Gary was of a ring of fibrous tissue seen on autopsy; this is the less common type of Schatzki ring.[1] More commonly, the ring consists of the same mucosal tissue that lines the entire esophagus.
Asymptomatic Schatzki rings seldom worsen over time, and need no treatment.[citation needed]
Symptomatic Schatzki rings may be treated withesophageal dilatation, using bougie or balloon dilators. These have been found to be equally effective.[8] Bougie dilatation involves passage of long dilating tubes of increasing size down the esophagus to stretch the area of narrowing, either over a guidewire passed into the stomach by endoscopy (theSavary-Gillard system) or usingmercury-weighted dilators (theMaloney system). This is usually done withintravenoussedation to reduce discomfort. Dilatation can produce some temporary irritation. A short course ofproton pump inhibitor therapy may decrease aggravation bystomach acid reflux into the esophagus. The duration of the benefit of dilation varies, but may be from months to years. Dilation may be repeated if narrowing recurs.[citation needed]
About 6 to 14 percent of patients who receive a routinebarium swallow test of the esophagus are found to have a Schatzki ring.[9]