Presentation
Longstanding gastro-esophageal reflux and dysphagia
Patient Data
Asymmetric fixed short segment narrowing at the gastroesophageal junction, just above a small hiatal hernia.
Case Discussion
These images show a typical appearance for a ringlike peptic stricture, which can be confused with a mucosal B-ring (or "Schatzki ring" if symptomatic). Both are reactions from long-standing exposure to refluxed gastric acid, but the pathogenesis of the peptic stricture involves fibrosis of the submucosa and muscularis propria, whereas the mucosal ring is a ringed proliferation of mucosa. The B-ring is thin (3 mm or less) and circumferential. A mucosal web would not be circumferencial, but would still be thin. When the indentation is thicker and asymmetric, then this implies that there is underlying fibrosis, compatible with stricture formation.