Schatzki rings

Clinical

Schatzki ring or lower esophageal ring were originally described by Schatzki as being a stenotic esophageal ring that caused dysphagia. Clinically patients typically present with episodes of dysphagia for solid foods. Often large food boluses become impacted above the stenotic ring and patients describe episodes of severe chest pain or an uncomfortable sensation behind their lower sternum. However, not all lower esophageal rings are classified as Schatzki rings. In fact most lower esophageal rings are often asymptomatic and therefore cannot be classified as Schatzki rings.

Pathogenesis

The exact pathogenesis of a Schatzki ring is still unknown. It is rare to see a symptomatic patient before the age of 50. Recent studies have postulated that a Schatzki ring represents a transformation of the gastroesophageal junction into an annular, ring-like structure due to scarring from reflux esophagitis.

Radiological findings

On radiographic studies, a Schatzki ring is often thin (2 to 4 mm in height) and the luminal opening is less than 13mm in diameter. Symptomatic obstruction is rare for openings greater than 13mm, but can be seen in rings between 13 to 20mm. A hiatal hernia is often also observed below the level of the ring.

The above esophagrams show a Schatzki ring (red arrow) at the distal esophagus