Schatzki's Ring

Definition

Described by Richard Schatzki, M.D., in 1953, Schatzki’s ring is a narrowing of the lower part of the esophagus caused by changes in the esophageal mucosa (lining of the esophagus).  In the majority of cases, Schatzki’s ring is benign and asymptomatic; the condition is associated with hiatal hernias and can disrupt the normal esophageal functions.

Causes

It has been suggested that long-term gastroesophageal reflux disease causes chronic inflammation and thus chronic damage to the lower esophagus. The damage will heal and form a scar that is the Schatzki’s ring. 

Symptoms

Patients with a Schatzki’s ring are usually asymptomatic. Any symptoms are directly associated with the extent of narrowing caused by the ring. Usually rings of 13 millimeters (0.5 inches) in diameter or narrower are the ones that cause symptoms. Patients can present with severe chest pain and intermittent dysphagia (difficulty swallowing). This condition can cause complete blockage of the esophagus and therefore food impaction. Patients will need to regurgitate the undigested foods to feel better.

Diagnosis

Diagnosis is usually done by upper endoscopy or by videoesophagram.

Both studies show narrowing at the end of the esophagus and the presence of a hiatal hernia.

An image of a Schatzki’s ring on an esophagram in shown in the image below.

An endoscopic view of a Schatzki’s ring is shown below.

Treatment

Alleviating the blockage by dilating the stricture is the mainstay of treatment for Schatzki’s ring. An inflatable balloon can be inserted under direct visualization with an endoscope and then inflated to break the ring open. Other tapered dilators can be used to break the ring. Patients are usually asked to stay on a clear liquid diet for 24 hours after the dilation. To prevent recurrence of the symptoms and the rings, a good control of the gastroesophageal reflux disease through habit changes and the use of proton pump inhibitors are necessary.

In patients with gastroesophageal reflux disease, an anti-reflux procedure may be necessary to prevent reflux and repair the hiatal hernia. The procedure can be performed via a minimally invasive approach called laparoscopic Nissen fundoplication.