Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
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
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.
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.
Stephanie Hawthorne, MD; American Board of Internal Medicine with subspecialty of Gastroenterology
"Management of benign esophageal strictures"