What is a Schatzki 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 of the esophagus with the stomach. These rings are common. The cause of these rings is not clearly understood, while 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, poorly chewed food (such as steak, turkey, frankfurter) that stays in chunks can get caught at the level of the ring. This occurs when the diameter of the ring reaches approximately 1 cm. The patient then experiences chest pain, or sticking sensation in the chest with swallowing (referred to as dysphagia). If the chunk of food passes into the stomach, these symptoms subside quickly and the patient can resume eating. If the food does not pass into the stomach, some patients have to induce regurgitation of the food by sticking their finger in the back of their throat before they can resume eating.
Rarely, the food becomes impacted (the food cannot pass nor can it be regurgitated). These patients experience continued chest pain and difficulty swallowing 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 Schatzki ring can usually be made by barium x- ray examination of the esophagus; however, a narrow ring can be missed on x-ray. In patients with symptoms of dysphagia, doctors usually also order an upper endoscope examination. Endoscopy is the best way of diagnosing a Schatzki ring. During the endoscopy, a flexible viewing tube is inserted through the mouth into the esophagus. It allows a direct view 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 involves 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, also by deflated balloons that are placed across the ring and are then blown up. Open surgery is hardly ever necessary to handle these rings.
Medically reviewed by Martin E. Zipser, MD; American Board of Surgery
"Management of benign esophageal strictures" uptodate.com
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