Thin (2-4 mm in height), web-like constriction at gastroesophageal junction
Margins: Smooth and symmetric
Sliding hiatal hernia seen below ring
• Schatzki ring best visualized
In prone right anterior oblique position
During suspended deep inspiration and Valsalva
With lumen distended with barium
TOP DIFFERENTIAL DIAGNOSES
• Reflux esophagitis
• Esophageal webs
• Esophageal carcinoma
• Muscular or contractile or A ring
CLINICAL ISSUES
• “Cheap steakhouse” syndrome: Due to inadequately chewed piece of meat impacted above ring
• Recurrent dysphagia; intermittent obstruction by food
Treatment: Mechanical disruption by bougienage or pneumatic dilation
DIAGNOSTIC CHECKLIST
• Need deep inspiration, Valsalva, distention to demonstrate Schatzki ring
• Give a 13 mm barium pill to judge diameter of ring
(Left) Graphic shows a small hiatal hernia and an annular ring-like narrowing at the gastroesophageal (GE) junction.
(Right) Film from a barium esophagram demonstrates a small hiatal hernia and a Schatzki ring with a luminal diameter of only 5-7 mm. Symptomatic narrowing of the B ring, which constitutes the Schatzki ring, probably results from reflux esophagitis.
(Left) In this young man with abrupt onset of chest pain after swallowing a piece of meat, a spot film from an esophagram shows a Schatzki ring with the piece of meat impacted above it.
(Right) Initial views of the esophagus (not shown) were normal. Repeat films, taken during deep inspiration and Valsalva maneuver, show the Schatzki ring at the GE junction. This lesion can be missed if it is tilted relative to the plane of imaging or if the esophagus is not optimally distended.
TERMINOLOGY
Definitions
• Annular, inflammatory, symptomatic narrowing of normal lower esophageal mucosal or B ring
IMAGING
General Features
• Best diagnostic clue
Thin, web-like, or annular constriction at gastroesophageal (GE) junction
• Size
< 13 mm in diameter, up to 20 mm
• Other general features
Most likely results from reflux esophagitis
– Has also been linked to eosinophilic esophagitis
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and an annular ring-like narrowing 
at the gastroesophageal (GE) junction.
and a Schatzki ring 
with a luminal diameter of only 5-7 mm. Symptomatic narrowing of the B ring, which constitutes the Schatzki ring, probably results from reflux esophagitis.
with the piece of meat 
impacted above it.
at the GE junction. This lesion can be missed if it is tilted relative to the plane of imaging or if the esophagus is not optimally distended.
Most likely results from reflux esophagitis
