SYB Case #4SYB Case #4

Jordan TorokJordan Torok

Class of 2010Class of 2010

Chief ComplaintChief Complaint

84 year old caucasian female with the 84 year old caucasian female with the sensation of food getting stuck in the sensation of food getting stuck in the retrosternal area, especially to solids such retrosternal area, especially to solids such as steak and chickenas steak and chicken

No regurgitationNo regurgitation

Resolves over timeResolves over time

No painNo pain

No weight lossNo weight loss

Differential Differential

Peptic stricturePeptic stricture

Eosinophilic Eosinophilic esophagitisesophagitis

Esophageal webs and Esophageal webs and ringsrings

CarcinomaCarcinoma

Cardiovascular Cardiovascular abnormalitiesabnormalities

Globus sensationGlobus sensation

Radiation injuryRadiation injury

AchalasiaAchalasia

Motility disordersMotility disorders

Diffuse esophageal Diffuse esophageal spasmspasm

SclerodermaScleroderma

Sjogren’s syndromeSjogren’s syndrome

Functional dysphagiaFunctional dysphagia

Evaluation of DysphagiaEvaluation of Dysphagia

Schatzki RingSchatzki RingLower esophageal ring is either mucosal Lower esophageal ring is either mucosal (Schatzki) or muscular (contractile)(Schatzki) or muscular (contractile)Schatzki ring is a thin, weblike constriction Schatzki ring is a thin, weblike constriction located at the squamocolumnar mucosal located at the squamocolumnar mucosal junction at or near the border of the LES junction at or near the border of the LES [Harrison’s][Harrison’s]May be congenital in origin or secondary to May be congenital in origin or secondary to GERDGERDTypically presents as episodic dysphagia, Typically presents as episodic dysphagia, particularly to solids although many are particularly to solids although many are asymptomaticasymptomaticTreated by dilatation and acid suppression Treated by dilatation and acid suppression Recurrence very commonRecurrence very common

Schatzki's ring at the gastro-esophageal junction.

Schatzki ring at the gastroesophageal junction visualized on a barium swallow. Courtesy of Peter J Kahrilas, MD. http://www.uptodate.com/online/content/image.do;jsessionid=ADAF13F21F74403300D519EFA48784EC.1104?imageKey=gast_pix/schatzki.htm&title=Schatzki%20ring%20Ba%20swallow