Lower esophageal (Schatzki's) ring: pathogenesis, diagnosis and therapy

Schatzki's or lower esophageal ring (LER) is one of the most common causes of solid food dysphagia. These rings are associated with hiatal hernias and appear to be produced by an infolding at the junction between the squamous and columnar mucosa. The pathogenesis of LER is not clear, but may be related to gastroesophageal reflux disease (GERD), while GERD and pill injury may worsen the dysphagia associated with LER. LERs are best diagnosed with a combination of history and a carefully performed barium esophogram with solid bolus challenge. Therapy includes instruction in slow and careful mastication. Bougienage is the main form of treatment, but selected patients may require pneumatic dilation, electrosurgical techniques or surgical repair. GERD should be treated if present in these patients.