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Schatzki ring

2007 Schools Wikipedia Selection. Related subjects: Health and medicine

   Endoscopic image of Schatzki ring, seen in the esophagus with the
   gastro-esophageal junction in the background.
   Enlarge
   Endoscopic image of Schatzki ring, seen in the esophagus with the
   gastro-esophageal junction in the background.

   A Schatzki ring or Schatzki-Gary ring is a ring found in the lower part
   of the esophagus that can cause difficulty swallowing. The ring is made
   up of mucosal tissue (which lines the esophagus) or muscular tissue.
   Patients with Schatzki rings can develop intermittent dysphagia or
   difficulty swallowing, or more seriously, with a completely blocked
   esophagus. The ring is named after the American physician, Richard
   Schatzki.

Clinical presentation

   Not all patients with Schatzki rings have symptoms; indeed, barium
   swallow tests of the esophagus will sometimes show Schatzki rings in
   patients who have no symptoms. When Schatzki rings cause symptoms, they
   usually result in episodic dysphagia to solid foods, or a sensation
   that the food "sticks" while swallowing. This particularly occurs if
   the food is not chewed properly. Cases of complete obstruction have
   been called the steakhouse syndrome: during a meal, there is a bolus
   obstruction of the esophagus with the foodstuff, resulting in acute
   crushing chest pain and dysphagia. Patients usually are able to
   regurgitate or force through the food material, but may need immediate
   treatment with endoscopy, which is the use of a specialized fibre-optic
   camera in order to remove the bolus of food that is lodged. This
   involves urgent endoscopy to locate the obstruction, followed by the
   insertion of devices to either pull the food out of the esophagus, or
   to push it into the stomach. The latter is usually done only with
   caution, or if the anatomy of the structures where the obstruction
   occurred is already known. Instruments passed through the endoscopy
   called snares and forceps can be used for these purposes.

Diagnosis

   When a patient has a suspect Schatzki ring, the physician can make the
   diagnosis by doing one of two tests: either an
   esophagogastroduodenoscopy or barium swallow. The endoscopy typically
   shows a ring within the lumen of the esophagus which can be of variable
   size. The ring is typically located a few centimetres above the
   gastro-esophageal junction, which joins the stomach and the esophagus.
   Schatzki rings can often resemble a related entity, called an
   esophageal web. Esophageal webs are similar in that they also contain
   extra mucosal tissue, but they do not completely encircle the
   esophagus.

   Endoscopies and barium swallows done for other reasons often show
   evidence of Schatzki rings, meaning that many Schatzki rings cause no
   symptoms.

   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 far less common type of Schatzki ring. More
   commonly, the ring consists the same mucosal tissue that lines the
   entire esophagus. Many hypotheses have been raised as to the cause of
   the Schatzki rings, but the cause is uncertain, and may be related to
   both congenital and acquired factors.

Treatment

   If asymptomatic, there is evidence that Schatzki rings do not progress
   to cause symptoms, and no treatment is suggested.

   Symptomatic Schatzki rings may be treated with esophageal dilatation,
   either using bougie or balloon dilators. These have been found to be
   equally effective. Bougie dilatation involves the passage of long
   dilating tubes of increasing size down the esophagus to stretch the
   area of narrowing. This is either done over a guidewire passed into the
   stomach by endoscopy (the Savary-Gillard system) or using
   mercury-weighted dilators (the Maloney system). It is usually done with
   intravenous sedation to ensure comfort. The duration of the effect of
   dilation varies between individuals, but may be from months to years.
   Dilatation may need to be repeated if further narrowing at the site of
   the ring occurs over time.

   After treatment with dilatation or endoscopic management of a bolus
   obstruction, there is often some trauma associated with the procedure.
   A short course of proton pump inhibitor therapy may be given to
   decrease stomach acid reflux into the esophagus, which may aggravate
   the area of trauma.

Other associations

     * Schatzki rings can be associated with swallowing syncope, a rare
       variety of syncope.
     * Schatzki rings are associated with a decreased incidence of
       Barrett's esophagus, which is considered to be a pre-cancerous
       condition of the esophagus in some cases.

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