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Schatzki Ring (Schatzki–Gary Ring) Overview A Schatzki ring is a narrow band of mucosal or muscular tissue forming in the lower esophagus, causing a structural narrowing (stricture) that can impede food passage into the stomach. Diagnostic Features Endoscopic View: •Appears as a smooth, concentric narrowing of the esophageal lumen. •Looks like a circular shelf of pinkish tissue. Barium Swallow (X-ray): •The ring shows as a sharp, thin, symmetrical indentation at the distal esophagus, just above the stomach. •This “ring-like” constriction is characteristic of Schatzki rings. Symptoms Many patients are asymptomatic, but when symptoms occur, they include: •Intermittent Dysphagia: Difficulty swallowing solid foods. •Steakhouse Syndrome: Complete food bolus obstruction (often meat), causing chest pain and requiring emergency endoscopic removal. •Sticking Sensation: Feeling that food is temporarily “stuck” in the lower chest. Causes and Associations •Gastroesophageal Reflux Disease (GERD): Chronic acid exposure may contribute to ring formation. •Hiatal Hernia: Frequently coexists with Schatzki rings. •Iron Deficiency Anemia: Sometimes associated with intermittent dysphagia; while this triad (with esophageal webs) is called Plummer-Vinson Syndrome, Schatzki rings are a distinct lower esophageal finding.

Female, 26 years old History: anorexia nervosa, depression. Admitted with complaints of diffuse abdominal pain. On examination: the abdomen is distended, tender to palpation, and there is tension in the anterior abdominal wall muscles. Weight: 27.2 kg, BMI: 9.71. The patient is dehydrated and unable to take small sips of water. Both lower extremities show signs of irreversible ischemia: femoral pulses are undetectable, and ultrasound Doppler imaging shows no blood flow. Neurological examination: complete loss of sensation in both legs, muscle strength 0/5 on the right and 3/5 on the left. Lab tests: white blood cell count: 17.9, acute kidney injury. Acid-base balance: pH 7.02, base deficit -19.5, lactate 16.5. Radiography and CT scan revealed a severely dilated stomach (reaching the pelvic cavity), no pneumoperitoneum. Signs of abdominal compartment syndrome were identified: hypoperfusion of the liver, spleen, and kidneys, severe aortic compression, and the inferior vena cava was not visualized. The left common iliac artery was compressed, with no visible distal vessels. On the right, the common femoral artery was visualized down to the popliteal artery. A diagnosis of pyloric obstruction was made. A nasogastric tube was inserted for decompression, along with a urinary catheter, and broad-spectrum antibiotics were initiated. Emergency decompression (laparotomy) was performed: a severely dilated, ischemic stomach, localized perforation, and duodenal dilation were visualized. A gastrotomy was performed, evacuating 15 liters of undigested food. Perfusion of the lower extremities was immediately restored, and the femoral pulse was restored. A temporary abdominal closure was performed, and a fasciotomy was performed to prevent compartment syndrome in the extremities after revascularization. Despite the treatment, the patient developed multiple organ failure and later died.