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Lower Esophageal Ring

(Schatzki Ring; B Ring)

By Kristle Lee Lynch, MD, Assistant Professor of Medicine, Perelman School of Medicine at The University of Pennsylvania

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A lower esophageal ring is a 2- to 4-mm mucosal stricture that causes a ringlike narrowing of the distal esophagus at the squamocolumnar junction that often causes dysphagia.

The etiology of lower esophageal rings is controversial; the leading theories are that they are congenital, or caused by acid reflux or pill-induced esophagitis.

These rings cause intermittent dysphagia for solids. Symptoms can begin at any age but usually do not begin until after age 25. The swallowing difficulty comes and goes and is especially aggravated by meat and dry bread. Symptoms usually occur only when the esophageal lumen is < 12 mm in diameter and never when it is > 20 mm.

Typically, evaluation of dysphagia begins with upper endoscopy, which should show a ring large enough to cause symptoms. If the distal esophagus is adequately distended, barium x-rays usually also show the ring.

Instructing the patient to chew food thoroughly is usually the only treatment required in wider rings, but narrow-lumen rings require dilation by endoscopy or bougienage. Surgical resection is rarely required.

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