Schatzki ring

Clinical History and Imaging 

55 year old male with intermittent retrosternal chest pain and dysphagia to solid food. Normal upper GI endoscopy. A barium swallow was performed.

Discussion 

Schatzki ring is a thin smooth web-like constriction at the gastro-esophageal junction that causes dysphagia or is producing esophageal narrowing with luminal diameter of less than 20mm. This distinguishes it from a lower esophageal mucosal ring which has the same radiologic appearance and location, but is asymptomatic and tends to be of a wider luminal calibre. Its exact etiology is uncertain. It affects 6-14% of the population and tends to present in the middle to older age groups. It is usually associated with a sliding type hiatus hernia. It is best demonstrated on prone single contrast esophagram as it is only visible if the esophagus above and below it is distended beyond the caliber of the ring. Its appearance is characteristic. Distal esophageal webs are uncommon and may have the same appearance, but these are located a few centimeters above the gastro-esophageal junction. Annular peptic strictures and carcinomas are unlikely to be mistaken for a Schatzki ring as they tend to be irregular in contour and are usually asymmetric.