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    Schatzki Ring: Daniel Ghossein

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    Daniel Ghossein
    This document discusses Schatzki's ring, which is a narrowing of the lower esophagus caused by a thin mucosal ring located at the squamocolumnar junction. It presents two main types - the muscular A ring and the more common mucosal B ring. The B ring is associated with hiatal hernia and causes episodic dysphagia to solids but not liquids. Diagnosis is made by barium esophagram or endoscopy and treatment involves dilation to disrupt the ring along with treating any reflux with PPIs. Recurrent dysphagia may require repeated dilations.

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    Schatzki Ring: Daniel Ghossein

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    Daniel Ghossein
    85 views9 pages
    This document discusses Schatzki's ring, which is a narrowing of the lower esophagus caused by a thin mucosal ring located at the squamocolumnar junction. It presents two main types - the muscular A ring and the more common mucosal B ring. The B ring is associated with hiatal hernia and causes episodic dysphagia to solids but not liquids. Diagnosis is made by barium esophagram or endoscopy and treatment involves dilation to disrupt the ring along with treating any reflux with PPIs. Recurrent dysphagia may require repeated dilations.

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    Schatzki's

    Original Title

    Schatzki RIng

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    This document discusses Schatzki's ring, which is a narrowing of the lower esophagus caused by a thin mucosal ring located at the squamocolumnar junction. It presents two main types - the muscular A ring and the more common mucosal B ring. The B ring is associated with hiatal hernia and causes episodic dysphagia to solids but not liquids. Diagnosis is made by barium esophagram or endoscopy and treatment involves dilation to disrupt the ring along with treating any reflux with PPIs. Recurrent dysphagia may require repeated dilations.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    85 views9 pages

    Schatzki Ring: Daniel Ghossein

    Uploaded by

    Daniel Ghossein
    This document discusses Schatzki's ring, which is a narrowing of the lower esophagus caused by a thin mucosal ring located at the squamocolumnar junction. It presents two main types - the muscular A ring and the more common mucosal B ring. The B ring is associated with hiatal hernia and causes episodic dysphagia to solids but not liquids. Diagnosis is made by barium esophagram or endoscopy and treatment involves dilation to disrupt the ring along with treating any reflux with PPIs. Recurrent dysphagia may require repeated dilations.

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    Schatzki Ring

    Daniel Ghossein
    Introduction

     1950s  Dysphagia + Lower Esophageal Ring-like


    Constrictions

     Ingelfinger and Kramer  ring occurred due to


    contraction of an overactive band of esophageal
    muscle.

     Schatzki and Gary  these rings are fixed and not


    contractile

     Muscular vs Mucosal Rings


    Introduction
    Esophageal Ring
     2Concentric
    rings have narrowing
    been identified
    of theinlumen
    the distal
    Esophagus:
    Most commonly located in the
     Muscular “A” Ring: thick band of muscle
    distal esophagus
    forming the upper border of the
    esophageal
    Two vestibule
    types: A ring and (2cm
    B ringabove the
    GEJ). Rare and not usually associated
    ▪ A ring: muscular ring in the proximal
    with dysphagia.
    esophagus at the junction of the tubular
     Mucosal “B” Ring: thin mucosal ring
    esophagus with the distal portion
    located at the Sq-C Junction. Common
    known
    and may as vestibule
    be asymptomatic or A
    ▪ B
    symptomatic depending
    ring (Schatzki’s on luminal
    ring or mucosal ring):
    diameter. B
    mucosal membrane in association with
    hiatal hernia just at the GE junction
    Pathophysiology

     Not Clear

     4 Hypotheses:
     The ring consists of redundant mucosa that forms when the esophagus
    shortens transiently or permanently. **
     The ring is congenital **
     The ring is a short peptic striciture forming due to GERD (protective)
     The ring is due to Pill Induced Esophagitis (chance observation  62%)

     Dysphagia depends on the luminal diameter  <13 mm and


    between 13-20 mm it depends on size and type of bolus.

     Mostly associated with hiatal hernia


    Epidemiology

     Quite Common

     No mortality has been noted

     Morbidity is variable

     > 40 years
    Clinical Presentation

     Episodic Dysphagia to Solids (not liquids) **

     Bolus may occasionally be forced by drinking liquids ** or


    Regurgitated

     Short lived

     Bread and meat mainly appear to be common foods that


    precipitate symptoms. “STEAKHOUSE SYNDROME”

     Others (Heartburn, GERD and regurgitation)

     Drooling upon complete obstruction of the lower esophagus


    for longer duration (rare) **
    Work Up

     Barium Esophagram

     Endoscopy

     Esophagogastroduodenoscopy: to confirm
    Treatment

     Treatment of symptomatic pt can be treated


    permanently with passage of large (17-20 mm) dilators
    that disrupt the mucosal ring.

     After dilation  treat any associated reflux disease (PPI)

     Subsequent dilatations needed for recurrences of


    dysphagia. If dysphagia persists consider manometry.

     Surgical Excision (rare)


    References

     http://emedicine.medscape.com/article/182647

     http://www.healthcentral.com/encyclopedia/hc/schatz
    kis-ring-3168815/

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