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
very common, occurring in more than 6% of the population. 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 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, 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.
GERD (gastroesophageal reflux disease) is a condition in which the acidified liquid
contents of the stomach backs up into the esophagus. The symptoms of uncomplicated GERD are heartburn,
regurgitation, and nausea. Effective treatment is available for most patients with GERD.
Esophageal cancer is a disease in which malignant cells form in the esophagus. Risk factors of cancer of the esophagus include smoking, heavy alcohol use, Barrett's esophagus, being male and being over age 60. Severe weight loss, vomiting, hoarseness, coughing up blood, painful swallowing, and pain in the throat or back are symptoms. Treatment depends upon the size, location and staging of the cancer and the health of the patient.
Eosinophilic esophagitis is an inflammation of the esophagus. Eosinophilic esophagitis has many causes including acid reflux, heartburn, viruses, medications that become stuck in the esophagus, allergy, asthma, hay fever, allergic rhinitis, and atopic dermatitis. Eosinophilic esophagitis symptoms include difficulty swallowing food, abdominal pain, chest pain, and heartburn.
Dysphagia or difficulty in swallowing, swallowing problems. Dysphagia is due to problems in nerve or muscle control. It is common, for example, after a stroke. Dysphagia compromises nutrition and hydration and may lead to aspiration pneumonia and dehydration.
Esophagitis is caused by an infection or irritation of the esophagus. Infections that cause esophagitis include candida yeast infection of the esophagus as well as herpes.
Barrett's esophagus occurs as a complication of chronic gastroesophageal reflux disease (GERD), primarily in white males. GERD refers to the reflux of acidic fluid from the stomach into the esophagus (the swallowing tube), and is classically associated with heartburn.
Heartburn is a burning sensation experienced from acid reflux (GERD). Symptoms of heartburn include chest pain, burning in the throat, difficulty swallowing, the feeling of food sticking in the throat, and a burning feeling in the chest. Causes of heartburn include dietary habits, lifestyle habits, and medical causes. Treatments for heartburn include lifestyle changes, OTC medication, prescription medication, and surgery.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Esophagitis is caused by an infection or irritation in the esophagus. An infection can be caused by bacteria, viruses, fungi, or diseases that weaken the immune system. Infections that cause esophagitis include:
Candida. This is a yeast infection of the esophagus caused by the same fungus that
causes vaginal yeast infections. The infection develops in the esophagus when the body's immune system is weak (such as in people with diabetes or
HIV). It is usually very treatable with antifungal drugs.
Herpes. Like Candida, this viral infection can develop in the esophagus when the body's immune system is weak. It is treatable with antiviral drugs.
Irritation causing esophagitis may be caused by any of the following:
GERD, or gastroesophageal reflux disease
Vomiting
Surgery
Medications such as aspirin and other anti-inflammatory drugs
Digestion RSS
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