Schatzki Ring

Michael P. Federle, MD, FACR

Key Facts

Terminology

Annular, inflammatory, symptomatic narrowing of normal lower esophageal mucosal or “B” ring

Imaging

Most likely results from reflux esophagitis
Classification based on ring diameter
- Ring < 13 mm in diameter: Symptomatic
- Ring 13-20 mm: Occasionally symptomatic
- Ring > 20 mm in diameter: Asymptomatic
Single-contrast barium esophagram
- Thin (2-4 mm in height), web-like constriction at gastroesophageal junction
- Margins: Smooth and symmetric
- Fixed, anatomic, nondistensible, transverse ring with constant shape
- 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

Recurrent dysphagia: Mechanical disruption of ring by
- Endoscopic rupture, bougienage, pneumatic dilation
- Electrocautery incision, rarely surgery

(Left) Graphic shows a small hiatal hernia and an annular ring-like narrowing at the gastroesophageal 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.