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Our purpose was to determine the prevalence of Barrett's esophagus in the presence of Schatzki ring. We performed a retrospective case-control study with an endoscopic database. Barrett's esophagus was present in 3 of 409 (0.73%) patients with Schatzki ring and in 16 of 888 (1.80%) patients without Schatzki ring. Short segment Barrett's esophagus was present in 3 cases and 10 controls. Long segment Barrett's esophagus was present in no cases and six controls. Logistic regression models adjusting for the presence of a hiatal hernia revealed a significant decrease in the odds of Barrett's esophagus in cases compared to controls (OR, 0.24; 95% CI, 0.07-0.87; P = 0:029). Barrett's esophagus is less prevalent in patients with Schatzki ring compared to patients without Schatzki ring. Long segment Barrett's esophagus was not observed in patients with Schatzki ring. A responsible protective effect or mutually exclusive pathophysiology should be considered.
KEY WORDS: Schatzki ring; Barrett's esophagus.
Schatzki ring is a circular membrane of mucosa in the distal esophagus that marks the squamocolumnar junction and is one of the most common contributing causes of episodic dysphagia. This ring was first described in 1944 by Templeton and further characterized in 1953 by Schatzki and Gary (1, 2). Although Schatzki ring has been recognized endoscopically and radiographically for many years, its etiology remains unclear; both chronic injury from gastroesophageal reflux disease and congenital or developmental factors have been proposed (3).
In 1962, Barrett suggested that Schatzki ring occurs in response to gastric acid exposure (4). In 1990, Marshall et al. prospectively studied the incidence of gastroesophageal reflux disease (GERD) in patients with a lower esophageal ring and dysphagia (5). Although symptomatic and endoscopic evidence of GERD was present in more than one-half of subjects, none was diagnosed with Barrett's esophagus.
Also controversial is the concept as to whether, once established, Schatzki ring protects against gastroesophageal reflux. Barrett believed Schatzki ring could be "nature's way of protecting the squamous epithelium above the barrier from further episodes of reflux esophagitis" (4).
We anecdotally observed that Barrett's esophagus and Schatzki ring, despite a potential common etiologic factor, did not commonly occur together, suggesting either a protective effect or a mutually exclusive predisposition. We performed this retrospective case-control study to examine this hypothesis.
METHODS
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