Schatzki’s Ring

Many years ago, Schatzki described a smooth, benign, circumferential, and narrow ring of tissue in the lower end of the esophagus (the food pipe that connects the mouth to the stomach). These rings are located just above the junction between the esophagus and the stomach. These rings are very common, occurring in more than 6% of the population. The cause of these rings is not clearly understood, some doctors believe they are caused by long-term damage from stomach acid reflux.

What are symptoms of a Schatzki Ring?
The majority of these rings cause no symptoms and patients are unaware of their presence. When the opening of the esophagus becomes smaller as the diameter of these rings shrink, solid and poorly chewed food (such as steak, turkey, frankfurter) can get caught at the level of the ring. The patient then experiences chest pain, or sticking sensation in the chest with swallowing (referred to as dysphagia). If the food bolus passes into the stomach, these symptoms subside quickly and the patient can resume eating. If the food bolus does not pass into the stomach, some patients have to regurgitate the obstructed bolus of food before they can resume eating. Rarely, the bolus becomes impacted (the food bolus cannot pass nor can it be regurgitated). These patients experience continued chest pain and difficulty handling saliva and secretions. A flexible endoscope has to be inserted through the mouth into the esophagus to extract the impacted food to relieve the obstruction.

How is a Schatzki Ring diagnosed?
The diagnosis of a Schatzki ring can usually be made by barium x-ray examination of the esophagus. In patients with symptoms of dysphagia, doctors usually also order an upper endoscope examination. During this examination, a flexible viewing tube is inserted through the mouth into the esophagus. It allows for direct visualization of the inner lining of the esophagus and the stomach. The test helps to exclude early cancer, esophagitis, and Barrett’s esophagus.

What treatment is for Schatzki Ring?
Management of these rings involve procedures that will stretch or fracture these rings, thus allowing freer passage of solid food. Stretching or fracturing can be performed with endoscopes, or tapered dilators inserted through the mouth, or dilator balloons placed across the ring by endoscopes. Open surgery is hardly ever necessary to handle these rings. Repeated procedures are sometimes necessary. Oftentimes medications to reduce acid reflux are prescribed.