Schatzki ring as a symptom of gastroesophageal reflux disease

Objective: to determine the importance of a symptom of Schatzki ring.

Material and methods. The results of examining 95 patients aged 62–92 years with the symptoms of dyspepsia in the Netanya State Geriatric Center (Israel) in 1994–2004 were analyzed. Standard X-ray study of the upper digestive tract was complemented by provocation tests. The length of an X-ray-negative area (XNA) between barium in the esophagus and stomach and the width in the lower esophagus were measured.

Results. Only 2 (2%) of the 95 patients were found to have normal function of the gastroesophageal junction (GEJ). Two patients with a drastic esophageal narrowing due to reflux esophagitis were excluded. The remaining (91) atients were divided into 2 groups. The width of the esophagus was less than 2 cm and 2 cm or more in 64 (70%) and 27 (30%) patients, respectively. In weak GEJ, there was esophageal dilatation above the XNA. When in a horizontal position, this portion of the esophagus evacuates its contents into the tomach as a result of ampullary function. It is proximally closed by ontracting the functional proximal sphincter (PS). When the ampulla contracts, its pressure increases up to the threshold. This causes the XNA to be closed and the ampulla to inject its contents into the stomach. The wider was the ampulla, the shorter the XNA was. Schatzki ring was detected in 20 (22%) of the 91  patients with gastroesophageal reflux disease (GERD). It was always at the level of the PS.

Conclusion. The so-called sliding esophageal hernia is an esophageal  mpulla measuring more than 2 cm in wide. The presence of the esophageal ampulla despite its size suggests that the GEJ is incompetent and GERD is present. Schatzki ring occurs at the level of the PS due to reflux esophagitis.

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