PROJECT TOPICS

Sunday, October 6, 2019

Schatzki Ring as appeared by Endoscope and barium swallow and more

 Overview of Schatzki ring:
A Schatzki ring also called Schatzki-Gary ring is a narrowing of the lower part of the esophagus that can cause intermittent dysphagia. The narrowing is caused by a ring of mucosal tissue (which lines the esophagus) or muscular tissue.And This ring is congenital in origin.





History of schatzki ring
Richard Schatzki was a renowned radiologist who described a ring-like structure in patients with dysphagia in articles from 1953 to 1963, and that structure would later bear his name. Schatzki ring is described as a circular membrane of mucosa and submucosa that is seen at the squamocolumnar junction of the distal esophagus. It appears as a thin membranous structure that does not contain any muscularis propria. It has an upper surface that is covered with squamous epithelium and a lower surface that is covered with columnar epithelium and is always associated with a hiatal hernia

Two rings have been identified in the distal esophagus.
Endoscopic image of Schatzki ring.
  • Muscular ring, or A ring, is a thickened symmetric band of muscle that forms the upper border of the esophageal vestibule and is located approximately 2 cm above the gastroesophageal junction. The A ring is rare; furthermore, it is even more rarely associated with dysphagia.
  • Mucosal ring, or B ring, is quite common and is the subject of discussion in this topic. The B ring is a diaphragmlike thin mucosal ring usually located at the squamocolumnar junction; it may be symptomatic or asymptomatic, depending on the luminal diameter. 
Patients typically present with intermittent nonprogressive dysphagia for solids. Fortunately, most patients respond well to initial and repeat dilatation therapy. A small number of patients may have stubborn rings that require more aggressive endoscopic or surgical intervention. 

This Prone, single-contrast barium esophagogram demonstrating Schatzki ring a thin, ringlike narrowing (arrows) in the lower esophagus just above a hiatal hernia. This view is most sensitive for detecting lower esophageal rings, provided adequate esophageal distention is achieved. 

Etiology of schatzki ring

As stated previously, Schatzki ring is associated with a hiatal hernia. Gastroesophageal reflux has been thought of as causing the ring. It has been postulated that the creation of a Schatzki ring is the body’s response to frequent acid exposure and natural way of preventing the development of Barrett’s esophagus. Studies have shown that Barrett’s esophagus is less common when a Schatzki’s ring is present, especially long-segment Barrett’s esophagus.






Signs and symptoms

Not all patients with Schatzki rings have symptoms; barium swallow tests of the esophagus sometimes show Schatzki rings in patients with no swallowing difficulties.
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 to regurgitate or force through the food material and resume eating. However, complete obstruction of the esophagus by a bolus of food (often called steakhouse syndrome) can occur. This can cause crushing chest pain and may need immediate treatment with endoscopy, which is the use of a specialized fibre-optic camera in order to remove the lodged food. After the obstruction is located, snares or forceps are inserted to pull the food out of the esophagus or to push it into the stomach. The latter is done with caution, usually when the anatomy of the structures around the obstruction is already known. 

How is Schatzki ring diagnosed?

The diagnosis of Schatzki ring can usually be made by barium X- ray examination of the esophagus; however, a narrow ring can be missed on X-ray. In patients with symptoms of dysphagia, doctors usually also order an upper intestinal endoscopy examination. Endoscopy is the best way of diagnosing a Schatzki ring. During the endoscopy, a flexible viewing tube is inserted through the mouth into the esophagus. It allows a direct view of the inner lining of the esophagus and the stomach. 
The test helps to exclude early cancer, esophagitis, and Barrett's esophagus that also may cause narrowing of the esophagus.

A Schatzki ring is usually diagnosed by esophagogastroduodenoscopy or barium swallow. Endoscopy usually shows a ring within the lumen of the esophagus which can be of variable size (see picture). The ring is usually located a few centimetres above the gastro-esophageal junction, where the esophagus joins the stomach. Schatzki rings can often resemble a related entity called an esophageal. Esophageal webs also contain extra mucosal tissue, but do not completely encircle the esophagus.

What causes Schatzki ring?

A Schatzki ring has been found to be present in 6 to 14 percent of routine barium swallowing studies. Symptoms are caused because of the narrow portion of the esophagus that makes up the Schatzki ring. The diameter of the Schatzki ring is very important as far as symptoms are concerned. Rings of a smaller diameter typically cause more frequent episodes of dysphagia than rings of a larger diameter.
Doctors aren’t sure what exactly causes a Schatzki ring to form. Gastroesophageal reflux disease, also known as GERD, is a possible cause of Schatzki ring formation. People with a Schatzki ring often have acid reflux disease as well. Additionally, conditions that can lead to reflux disease, such as a hiatal hernia, are often found in people with a Schatzki ring.





Treatment for a Schatzki ring

Therapy provided to individuals with a Schatzki ring includes balloon dilation of their esophagus. This is a procedure that uses an instrument with a small balloon on the end to manually increase the diameter of the Schatzki ring. Typically, a decrease in symptoms is reported shortly after the dilation procedure. Based on the association between the presence of a Schatzki ring and GERD, acid suppression therapy alone or with balloon dilation has also been shown to be effective in relieving symptoms.

Changes to eating patterns

A Schatzki ring often leads to difficulty in swallowing solid foods, so it’s important to make sure that you eat slowly and chew all food thoroughly before swallowing. It may also be helpful to take in a smaller amount of food per bite. Additionally, changing the food that you eat to avoid consumption of large or tough items may help you avoid a food blockage of the esophagus.

Outlook for a Schatzki ring

A Schatzki ring is a narrowing of the lower esophagus and the leading cause of dysphagia of solid foods in adults. Schatzki rings are often asymptomatic. Typically, symptoms occur when a Schatzki ring is of a small diameter. These symptoms include:
  • difficulty in swallowing solid food items
  • feeling as if food is getting stuck in your chest
  • heartburn