| Schatzki ring Classification and external resources |
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| Endoscopic image of Schatzki ring, seen in the esophagus with the gastro-esophageal junction in the background. The esophagus or oesophagus (see American and British English spelling differences) sometimes known as the gullet, is an organ in The cardia (also known as Z-line or esophagogastric junction or gastroesophageal junction) is the anatomical term for the junction orifice of | |
| ICD-10 | K22.2, Q39.3 |
| ICD-9 | 530.3, 750.3 |
| DiseasesDB | 31504 |
| eMedicine | med/2069 |
A Schatzki ring or Schatzki-Gary ring is a ring found in the lower part of the esophagus that can cause difficulty swallowing. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings K00-K93 - Diseases of the digestive system (K00-K14 Diseases of oral cavity salivary glands and jaws ( Disorders of Tooth development and Eruption Q00-Q89 - Congenital malformations and deformations (Q00-Q07 Nervous system ( Anencephaly and similar malformations The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors The esophagus or oesophagus (see American and British English spelling differences) sometimes known as the gullet, is an organ in The ring is made up of mucosal tissue (which lines the esophagus) or muscular tissue. The mucous membranes (or mucosae; singular mucosa) are linings of mostly endodermal origin covered in Epithelium, which are involved in [1] Patients with Schatzki rings can develop intermittent dysphagia (difficulty swallowing), or, more seriously, a completely blocked esophagus. Dysphagia should not be confused with the similarly pronounced Dysphasia, a language disorder The ring is named after the American physician Richard Schatzki. Richard Schatzki (1901-1992 was a German - American Radiologist.
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Clinical presentation
Not all patients with Schatzki rings have symptoms; indeed, barium swallow tests of the esophagus will sometimes show Schatzki rings in patients who have no symptoms. A barium swallow is a Medical imaging procedure used to examine the upper GI (gastrointestinal tract which includes the esophagus and to a lesser extent the stomach When Schatzki rings cause symptoms, they usually result in episodic dysphagia with solid foods, or a sensation that the food "sticks" while swallowing. This particularly occurs if the food is not chewed thoroughly. Cases of complete obstruction have been called steakhouse syndrome: during a meal, there is a bolus obstruction of the esophagus with the foodstuff, resulting in acute crushing chest pain and dysphagia. An esophageal food bolus obstruction (or steakhouse syndrome) is a medical emergency caused by the obstruction of the Esophagus by an ingested Foreign In Medicine, chest pain is a Symptom of a number of serious conditions and is generally considered a Medical emergency. Patients usually are able to regurgitate or force through the food material, but may need immediate treatment with endoscopy, which is the use of a specialized fibre-optic camera in order to remove the lodged food. Vomiting (also called throwing up, emesis) is the forceful expulsion of the contents of one's Stomach through the Mouth and sometimes the Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an instrument called an endoscope. An optical fiber (or fibre) is a Glass or Plastic fiber that carries Light along its length [2] This involves urgent endoscopy to locate the obstruction, followed by the insertion of devices to either pull the food out of the esophagus, or to push it into the stomach. In Human anatomy, the stomach is a J-shaped hollow muscular organ of the Gastrointestinal tract involved in the second phase of Digestion, following The latter is usually done only with caution, or if the anatomy of the structures where the obstruction occurred is already known. Snares and forceps passed through the endoscope can be used for these purposes. Forceps are a handheld hinged instrument used for grasping and holding objects
Diagnosis
When a patient has a suspect Schatzki ring, the physician can make the diagnosis by doing one of two tests: either an esophagogastroduodenoscopy or barium swallow. A barium swallow is a Medical imaging procedure used to examine the upper GI (gastrointestinal tract which includes the esophagus and to a lesser extent the stomach The endoscopy typically shows a ring within the lumen of the esophagus which can be of variable size. A lumen (Lat lūmen, an opening or light (pl lumina is the inside space or lining of a tubular structure such as an artery or intestine The ring is typically located a few centimetres above the gastro-esophageal junction, which joins the stomach and the esophagus. The cardia (also known as Z-line or esophagogastric junction or gastroesophageal junction) is the anatomical term for the junction orifice of Schatzki rings can often resemble a related entity, called an esophageal web. Esophageal webs are thin membranes located in the middle or upper Esophagus. Esophageal webs are similar in that they also contain extra mucosal tissue, but they do not completely encircle the esophagus.
Endoscopies and barium swallows done for other reasons often show evidence of Schatzki rings,[3] meaning that many Schatzki rings are asymptomatic.
Two varieties of Schatzki rings have been described. The original description by Schatzki and Gary was of a ring of fibrous tissue seen on autopsy; this is the far less common type of Schatzki ring. [1] More commonly, the ring consists of the same mucosal tissue that lines the entire esophagus. Many hypotheses have been raised as to the cause of the Schatzki rings, but the cause is uncertain, and may be related to both congenital and acquired factors. A congenital disorder is a disease or disorder that is present at birth An acquired disorder is a Medical condition which develops post- Fetally in contrast with a Congenital disorder, which is present at Birth
Treatment
If asymptomatic, there is evidence that Schatzki rings do not progress to cause symptoms, and no treatment is suggested.
Symptomatic Schatzki rings may be treated with esophageal dilatation, either using bougie or balloon dilators. Esophageal dilatation is a therapeutic endoscopic procedure that enlarges the lumen of the Esophagus. These have been found to be equally effective. [4] Bougie dilatation involves the passage of long dilating tubes of increasing size down the esophagus to stretch the area of narrowing. This is either done over a guidewire passed into the stomach by endoscopy (the Savary-Gillard system) or using mercury-weighted dilators (the Maloney system). Mercury (ˈmɜrkjʊri also called quicksilver or hydrargyrum, is a Chemical element with the symbol Hg ( Latinized hydrargyrum This is usually done with intravenous sedation to ensure comfort. Intravenous therapy or IV therapy is the giving of Liquid substances directly into a Vein. Sedation is a Medical procedure involving the administration of Sedative drugs generally to facilitate a medical procedure with Local anaesthesia. The duration of the effect of dilation varies between individuals, but may be from months to years. Dilation may need to be repeated if further narrowing at the site of the ring occurs over time.
After treatment with dilatation or endoscopic management of a bolus obstruction, there is often some trauma associated with the procedure. A short course of proton pump inhibitor therapy may be given to decrease stomach acid reflux into the esophagus, which may aggravate the area of trauma. Proton pump inhibitors (or "PPI"s are a group of drugs whose main action is pronounced and long-lasting reduction of Gastric acid production
Other associations
- Schatzki rings can be associated with swallowing syncope, a rare variety of syncope. [5]
- Schatzki rings are associated with a decreased incidence of Barrett's esophagus, which is considered to be a pre-cancerous condition of the esophagus in some cases. Barrett's esophagus (UK Oesophagus (sometimes called Barrett's syndrome, CELLO, columnar epithelium lined lower oesophagus or colloquially as Barrett's [6]
See also
References
- ^ a b Schatzki, Richard; J. Dysphagia should not be confused with the similarly pronounced Dysphasia, a language disorder Esophageal webs are thin membranes located in the middle or upper Esophagus. Richard Schatzki (1901-1992 was a German - American Radiologist. E. Gary (December 1953). "Dysphagia due to a diaphragm-like localized narrowing in the lower esophagus (lower esophageal ring)". The American journal of roentgenology, radium therapy, and nuclear medicine 7) (6): 911–22. PMID 13104726.
- ^ Stadler, J. ; A. H. Hölscher, H. Feussner, J. Dittler and J. R. Siewert (December 1989). "The "steakhouse syndrome". Primary and definitive diagnosis and therapy". Surgical Endoscopy 3 (4): 195–8. doi:. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 2623551.
- ^ Pezzullo, john C. ; Ann M. Lewicki (September 2003). "Schatzki ring, statistically reexamined". Radiology 228 (3): 609–13. doi:. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 12869689.
- ^ Scolapio, James S. ; Tousif M. Pasha, Christopher J. Gostout, Douglas W. Mahoney, Alan R. Zinsmeister, Beverly J. Ott and Keith D. Lindor (July 1999). "A randomized prospective study comparing rigid to balloon dilators for benign esophageal strictures and rings". Gastrointestinal Endoscopy 50 (1): 13–7. doi:. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 10385715.
- ^ Gawrieh, Samer; Ty Carroll, Walter J. Hogan, Konrad H. Soergel and Reza Shaker (October 2005). "Swallow syncope in association with Schatzki ring and hypertensive esophageal peristalsis: report of three cases and review of the literature". Dysphagia 20 (4): 273–7. doi:. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 16633871.
- ^ Mitre, Marcia C. ; David A. Katzka, Colleen M. Brensinger, James D. Lewis, Ricardo J. Mitre and Gregory G. Ginsberg (May 2004). "Schatzki ring and Barrett's esophagus: do they occur together?". Digestive Diseases and Sciences 49 (5): 770–3. doi:. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 15259497.
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