SYB Case

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SYB Case 4

• Jordan Torok
• Class of 2010

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Chief Complaint

• 84 year old caucasian female with the sensation
  of food getting stuck in the retrosternal area,
  especially to solids such as steak and chicken
• No regurgitation
• Resolves over time
• No pain
• No weight loss

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Differential

• Peptic stricture
• Eosinophilic esophagitis
• Esophageal webs and rings
• Carcinoma
• Cardiovascular abnormalities
• Globus sensation

• Radiation injury
• Achalasia
• Motility disorders
• Diffuse esophageal spasm
• Scleroderma
• Sjogrens syndrome
• Functional dysphagia

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Evaluation of Dysphagia
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Schatzki Ring

• Lower esophageal ring is either mucosal
  (Schatzki) or muscular (contractile)
• Schatzki ring is a thin, weblike constriction
  located at the squamocolumnar mucosal junction at
  or near the border of the LES Harrisons
• May be congenital in origin or secondary to GERD
• Typically presents as episodic dysphagia,
  particularly to solids although many are
  asymptomatic
• Treated by dilatation and acid suppression
• Recurrence very common

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Schatzki's ring at the gastro-esophageal
junction.
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Schatzki ring at the gastroesophageal junction
visualized on a barium swallow. Courtesy of Peter
J Kahrilas, MD. http//www.uptodate.com/online/con
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48784EC.1104?imageKeygast_pix/schatzki.htmtitle
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