A Schatzki ring is a common, non-cancerous narrowing of the lower esophagus. This condition is characterized by a thin, circumferential fold of tissue that constricts the passage. While many people with this ring may have no symptoms, its presence is a frequent anatomical cause of difficulty swallowing.
Anatomy of the Schatzki Ring
The Schatzki ring is a specific type of esophageal ring, technically known as a B-ring, which forms precisely at the esophagogastric junction (EGJ). This is the point where the squamous epithelium of the esophagus meets the columnar epithelium of the stomach. The ring consists of a fold of both the mucosal and submucosal layers of the esophageal wall.
The physical structure acts like a diaphragm, reducing the diameter of the esophageal lumen. The size of the opening directly relates to the likelihood of symptoms: rings less than 13 millimeters are almost always symptomatic, while those wider than 20 millimeters generally cause no symptoms.
Understanding the Underlying Causes
Current evidence points to chronic inflammation as the primary mechanism for Schatzki ring development. The most common source of this irritation is gastroesophageal reflux disease (GERD), where stomach acid flows backward into the lower esophagus.
Long-term exposure to harsh acid damages the esophageal lining, and the subsequent healing process involves scarring and the formation of fibrous, constricting tissue. The ring is thought to be an acquired feature, developing over time in response to repeated acid injury. The condition is also frequently associated with a hiatal hernia, where the upper part of the stomach pushes up through the diaphragm. This displacement increases chronic acid exposure, contributing to the ring’s formation.
How a Schatzki Ring Presents
The main symptom of a Schatzki ring is intermittent dysphagia, the medical term for difficulty swallowing. This sensation occurs primarily with solid foods, particularly those that are dry or poorly chewed, such as meat or bread, and is felt as food getting “stuck” in the lower chest.
Symptoms are often episodic because liquids and softer foods typically pass through the narrowed opening without issue. Many individuals manage their condition by chewing food more thoroughly and drinking liquids with meals. A more significant presentation is food impaction, where a large bolus of food completely blocks the esophagus at the ring site. This painful medical event, sometimes called “steakhouse syndrome,” prevents swallowing and requires immediate medical attention.
Identification and Management
Diagnosis often begins with a Barium Swallow X-ray, where the patient swallows a contrast agent to coat the esophageal lining. This visualizes the narrowed ring and helps determine its diameter. An upper endoscopy is also routinely performed to directly visualize the ring, rule out other causes of swallowing difficulty, and take tissue samples if needed.
The primary treatment for a symptomatic ring is endoscopic dilation, a procedure designed to stretch and widen the constricted area. This is typically performed during an endoscopy using a specialized balloon or tapered dilators passed through the ring. The goal is to achieve a diameter of at least 16 to 20 millimeters to ensure comfortable food passage.
To maintain results and prevent recurrence, long-term medical management is necessary. This involves using acid-suppressing medications, most commonly Proton Pump Inhibitors (PPIs), to treat the underlying GERD. Combining dilation with long-term acid suppression significantly reduces the risk of the ring recurring and requiring repeat procedures.