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
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.