Which statement best differentiates a peptic esophageal stricture from a Schatzki ring on endoscopy?

• A. Schatzki ring is a mucosal ring at the distal esophagus causing intermittent solid-dysphagia.
• B. A stricture is a mucosal ring at the distal esophagus causing intermittent solid-dysphagia.
• C. A stricture is a narrowing due to inflammation/scar.
• D. A Schatzki ring is a narrowing due to inflammation/scar.

Answer: (C)

The key idea is that endoscopy differentiates a peptic stricture from a Schatzki ring by what each lesion actually is in the esophageal wall. A peptic stricture is a true narrowing of the lumen caused by inflammation and scar tissue, so the endoscope will show a constricted segment resulting from fibrotic remodeling that tightens the wall. A Schatzki ring, on the other hand, is a thin mucosal ring at the distal esophagus near the gastroesophageal junction that creates a focal constriction but involves mainly the mucosa rather than deep fibrotic narrowing. Because the distinguishing feature is the tissue depth and nature of the narrowing, the statement that best differentiates them on endoscopy is that a stricture is a narrowing due to inflammation and scar. The Schatzki ring is a mucosal ring at the distal esophagus causing intermittent solid-dysphagia, which describes its appearance and location but does not capture the deeper fibrotic narrowing seen with a true stricture.