Schatzki's Ring
Schatzki's ring is a narrowing at the end of the esophagus, just above where it attaches to the stomach. Also known as an esophageal stricture, Schatzki's ring, an area narrower than the rest of the esophagus, can interfere with normal swallowing and digestive motility. Although a benign (non-malignant) condition that does not always result in symptoms, Schatzki's ring can cause intense discomfort and may result in unintentional weight loss or even, in severe cases, dehydration or malnourishment.
Causes of Schatzki's Ring
In some cases, Schatzki's ring is a congenital defect. It may also result from:
- Gastroesophageal reflux disease (GERD)
- Injuries from an endoscopy
- Swallowing of toxins, such as lye or battery acid
- Long-term use of a nasogastric tube
- Treatment of esophageal varices (enlarged blood vessels)
Symptoms of Schatzki's Ring
Many individuals are unaware that they have this disorder and remain asymptomatic. Symptoms, when they occur, are often the result of incomplete chewing of food, particularly meat, large particles of which can get trapped at the esophageal stricture before reaching the stomach. When this occurs, the patient may present with acute symptoms. Often these problems resolve on their own, but in severe cases, they may require medical intervention.
Acute symptoms associated with Schatzki's ring include:
- Difficulty or pain when swallowing
- Coughing or choking
- Regurgitation of food
In patients where episodes recur frequently, more troubling long-term symptoms, such as unintentional weight loss, may become apparent.
Diagnosis of Schatzki's Ring
Any problems with swallowing, known as dysphagia, should be reported to the doctor. After a thorough physical examination and medical history, such symptoms are typically diagnosed through the performance of an upper endoscopy and the administration a barium swallow, both of which provide the physician with detailed images of the lining of the stomach and the esophagus and show any areas of esophageal strictures.
Treatment of Schatzki's Ring
When the patient is asymptomatic and Schatzki's ring is detected during screening for other issues, no treatment is necessary. When the patient is experiencing difficulty swallowing, however, medication or a medical procedure may be recommended. Treatments for this condition may include:
- Medication to decrease acid reflux (proton-pump inhibitor)
- Esophageal dilation through endoscopy
The esophageal dilation may be performed simply with a dilating device or with the assistance of a balloon inflated to widen the ring. Dilation of Schatzki's ring is almost always effective, but patients may have to continue taking proton pump inhibitors to keep the stricture from recurring. Rarely, a surgical procedure may be needed to deal with Schatzki's ring. It is possible, however, that, at sometime in the future, the endoscopic dilation will have to be repeated.