Several years ago, a German-American physician named Richard Schatzki described a non-malignant, smooth, narrow, and circumferential ring of tissue occurring in the lower part of esophagus, which is the food pipe that joins the stomach to the mouth. These rings are known as Schatzki rings, and are situated just above the meeting point of the stomach and the esophagus. They are quite common and can be observed in more than six percent of the population. The precise cause of the Schatzki rings is still a subject of research, but some physicians consider them to be caused by prolonged damage resulting from stomach acid reflux.
A Schatzki ring thus refers to constriction of the lower section of the esophagus which can lead to swallowing difficulties. The constriction is understood to be caused by a ring made of muscular tissue or mucosal tissue that can be found in the linings of the esophagus. Individuals affected by Schatzki rings can experience sporadic dysphagia, i.e. swallowing problems. Severe cases of the condition can result in complete obstruction of the esophagus.
A Schatzki ring refers to a particular kind of ‘esophageal ring’ with further sub-categorization into B rings and A rings. A ring appearing just above the junction of the stomach and esophagus is known as an A ring, while a B ring can be noticed at the squamocolumnar junction, in the lower esophagus.
Symptoms of a Schatzki ring
A majority of the people affected by Schatzki rings, generally are not aware about their occurrence, and hence they do not notice any signs or symptoms of the condition.
The symptoms of Schatzki rings are as follows:
- When the esophageal opening becomes smaller due to shrinking of the diameter of Schatzki rings, then poorly chewed and firm foodstuffs like turkey, steak, frankfurter, etc. remain as chunks of food and have a tendency to get trapped at the level of the rings. This tends to happen when the ring diameter reaches an estimated 1 cm.
- The affected person may then elicit pain in the chest, or a sticky feeling in the chest after swallowing. This peculiar symptom is known as dysphagia. The passage of the food chunk into the stomach results in rapid subsiding of the symptoms, which allows the patient to carry on eating.
- If the food is not allowed to go into the stomach, then few patients need to induce regurgitation of the eatables by inserting a finger in the back of the throat. Then they can restart eating.
- In rare cases, the eatables may be impacted, wherein the food cannot be regurgitated, nor can be passed through. Such affected people experience constant pain in the chest and problems in swallowing saliva and other emissions. In this case, the obstruction is removed by extracting the impacted food with the aid of a flexible endoscope that is stuck via the mouth into the esophagus.
Some of the complications of Schatzki rings are listed below:
- Dilatation can result in perforation or bleeding. However, spontaneous puncturing of the Schatzki rings is rarely occurs
- Aspiration pneumonitis
- Intense dysphagia can result in malnutrition
- The vulnerability of a malignant alteration of the Schatzki rings poses increased risk to developing Paterson Brown-Kelly syndrome. However, the iron deficiency correction tends to reverse the disease as well as the risk.
- Complete blockage of food can be severely discomforting and requires elimination via endoscopy
Schatzki ring causes
- An esophageal ring affecting the lower section is a congenital defect that be observed in four percent of the population. This causes constriction of the lower esophagus
- A Schatzki ring may also be caused due to esophageal narrowing resulting from tumors and injuries
Diagnosis of a Schatzki ring
- The diagnosis of a Schatzki ring can normally be carried out via examination of the esophagus by barium X-ray. However, a narrow ring may not be visible on X-ray
- In individuals experiencing symptoms of dysphagia, physicians also normally opt for an upper endoscope examination. An endoscopy is a reliable method of detecting a Schatzki ring. In an endoscopy, a flexible viewing tube is put via the mouth into the esophagus, which allows a clear view of the stomach and the inner sections of the esophagus. The test also helps in ruling out esophagitis, early cancer and Barrett’s esophagus
Schatzki ring treatment
- Schatzki rings that do not cause symptoms rare worsen with time and require no treatment
- Esophageal dilatation via balloon or bougie dilators is used to treat symptomatic cases of a Schatzki ring. In bougie dilatation, long dilating tubes of growing size are passed down the esophagus to expand the narrowed area, wherein either a guide-wire is passed into the stomach via endoscopy, or by employing mercury-weighted dilators. Intravenous sedation can decrease discomfort. The distress caused by stomach acid reflux into the esophagus is reduced by a temporary course of proton pump inhibitor therapy.
- Open surgery is rarely required to treat cases of Schatzki rings.