1. SYB Case #4 Jordan Torok Class of 2010

2. 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

3. Differential Peptic stricture Eosinophilic esophagitis Esophageal webs and rings Carcinoma Cardiovascular abnormalities Globus sensation Radiation injury Achalasia Motility disorders Diffuse esophageal spasm Scleroderma Sjogren’s syndrome Functional dysphagia

4. Evaluation of Dysphagia

13. 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 [Harrison’s] 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

14. Schatzki's ring at the gastro-esophageal junction.

15. 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=ADAF13F21F74403300D519EFA48784 EC.1104?imageKey=gast_pix/schatzki.htm&title=Schatzki%20ring%20Ba%20swallow