Schatzki Ring*

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.

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.

I have to have Esophagial Dilation at least once a year due to this problem. Many trips to the emergency room because it feels like a heart attack.

Gastroenterologists often see patients who experience episodes of difficulty in swallowing solid foods, such as steak. In most cases, the problem stems from an abnormality known as a Schatzki's ring. This ring is basically a mild narrowing caused by fibrous scar tissue in the lower esophagus. The origin of this ring is in dispute. Some doctors think it is present from birth and only causes problems in later years. However, most gastroenterologists believe that it is a result of chronic gastroesophageal reflux (GERD). The acid reflux may not be severe enough to cause heartburn or other discomfort, but it may silently trigger inflammation in the lower esophagus, leading to the formation of a scar-tissue ring.

A Schatzki's ring is most often detected during tests (such as an upper endoscopy or a radiographic upper GI barium series) that are being done for unrelated digestive complaints. Most of the rings found do not cause symptoms and need no therapy.

In those patients who do experience problems, the most common symptom is intermittent episodes of difficulty in swallowing (dysphagia). Since the ring is only a minor narrowing of the esophagus, most food particles and all liquids easily pass down the esophagus. However, large pieces of solid food, such as steak, chicken or bread, occasionally get stuck in the esophagus at the ring. Patients can sometimes drink liquids to move the food past the ring, or they may vomit up the piece of food. In some cases, the food gets stuck and cannot be dislodged. Patients in this situation often come to the emergency room, where an endoscopy is done to make the diagnosis and get the food unstuck. When a Schatzki's ring is discovered in this fashion, the problem is sometimes called "steakhouse syndrome."


The therapy for a Schatzki's ring is dilation, or stretching, of the ring to break it and prevent further episodes. Dilation involves sedating the patient, placing a flexible tube in the esophagus and passing the tube down to the stomach.

It is important to keep in mind that although difficulty in swallowing steak or other solid food is very consistent with a Schatzki's ring, other diagnoses must be ruled out. These include esophageal stricture (a more severe narrowing, usually because of reflux) or esophageal cancer. Thus, an upper endoscopy is an important test to perform in any patient with dysphagia. You should get a referral to a gastroenterologist to discuss your symptoms.