What are the other Names for this Condition? (Also known as/Synonyms)

• Esophageal “B” Ring
• Schatzki-Gary Ring

What is Schatzki Ring? (Definition/Background Information)

• Schatzki Ring is a condition that is characterized by a narrowing of the esophagus (food-pipe), due to benign growths in the lower part of the esophagus. It is mostly observed in middle-aged and older adults
• Depending on where the growth occurs, there are 2 types of Schatzki Rings:
  • Type A ring (called muscular ring) - when it occurs nearly at the end of the esophagus, just above the vestibule (which is present above the stomach)
  • Type B ring (called Schatzki Ring) - when it occurs in junction of the glandular and squamous mucosa in the lower end of the esophagus
• Depending on the degree of constriction, the symptoms may be mild or severe and may include swallowing difficulties, and very infrequently fainting. However, unlike Plummer-Vinson syndrome (a disorder with similar features), Schatzki Ring is not reported to be associated with iron-deficiency anemia
• Currently, the cause of Schatzki Ring is unknown. It is associated with gastroesophageal reflux disease and Barrett’s esophagus. The condition may be diagnosed by a healthcare professional through physical exam, imaging tests of the esophagus, and barium swallow
• Upon diagnosis, treatment options for Schatzki Ring, such as modifying one’s eating habits, may be suggested. In case of severe obstruction, the esophagus may be mechanically dilated (expanded)
• The prognosis of Schatzki Ring is generally good with treatment, but complications, such as trauma/tears in the gastrointestinal tract during treatment, may worsen the prognosis. Also, following dilation of the constricted food-pipe, the condition may recur

Who gets Schatzki Ring? (Age and Sex Distribution)

• Schatzki Ring usually presents itself in adults over the age of 40 years. Rarely, the condition has been observed in children
• Men and women of different racial and ethnic backgrounds can be affected and no preference is observed

What are the Risk Factors for Schatzki Ring? (Predisposing Factors)

Presently, the following risk factors for Schatzki Ring have been identified:

• Acid-reflux disease
• Presence of Barrett’s esophagus (formation of small intestinal glands in the esophagus)
• It is known to be associated with hiatal hernia 

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Schatzki Ring? (Etiology)

• The cause of Schatzki Ring is generally unknown
• Research scientists have proposed several hypotheses in explanation of the same, although none have been definitively proven

What are the Signs and Symptoms of Schatzki Ring?

The signs and symptoms of Schatzki Ring may vary between individuals. Some may have mid symptoms, while others, severe symptoms, depending on the degree of esophageal constriction. In some individuals, the condition may be asymptomatic and discovered only incidentally, while the healthcare provider examines for other medical conditions. 

The signs and symptoms of Schatzki Ring may include the following:

• The ring causes periodic swallowing difficulties; solid foods are more difficult to swallow than liquid foods
• The swallowing difficulties may be intermittent and based on the kind of food being ingested
• Pain after swallowing the food
• Impaction of food: Obstruction of food pieces (such as meat) in the esophageal ring
• The symptoms are not known to progress with time

How is Schatzki Ring Diagnosed?

A healthcare professional can diagnose Schatzki Ring through:

• A physical examination and analysis of previous medical history
• Upper GI series: X-rays are used to view the esophagus, stomach, and small intestine, to look for deformities or growths. This may also help eliminate Plummer-Vinson Syndrome (a condition that presents similar features)
• Barium swallow
• Esophagogastroduodenoscopy (EGD): Examination of the lining of the esophagus, stomach, and beginning parts of the small intestine, with a small camera that is guided to the area of interest
• Videofluoroscopy: A video swallowing study using a small camera that is guided to the area of interest
• Blood tests to rule-out anemia or iron deficiency

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Schatzki Ring?

The complications of Schatzki Ring may include:

• Some cases are associated with fainting, a condition termed ‘swallow syncope’
• Complete obstruction of the esophagus, which can be a serious condition
• Extremely rarely, esophageal perforation may occur
• Injury to the esophagus (tears) from medical devices used to stretch the esophagus during diagnosis and/or treatment
• Recurrence of the condition following treatment

How is Schatzki Ring Treated?

The treatment of Schatzki Ring is determined by a healthcare professional and the following may be considered:

• Widening and stretching of the tissue in the esophagus, which is contracting the lumen of the esophagus, during esophagogastroduodenoscopy (the constricted portion is dilated)
• Eating foods slowly, chewing thoroughly, and eating meals in small bites; taking liquids or semi-solid foods
• In some cases of no symptoms or mild symptoms, no treatment may be undertaken and the healthcare provider may choose to regularly monitor the condition
• Undertaking treatment of gastroesophageal reflux disease (GERD) and Barrett’s esophagus, if any

How can Schatzki Ring be Prevented?

Currently, Schatzki Ring is not a preventable condition, as the cause of the condition is still unknown.

What is the Prognosis of Schatzki Ring? (Outcomes/Resolutions)

• The prognosis of Schatzki Ring is generally good with appropriate treatment
• In case an esophageal dilation is performed to widen the narrowed food-pipe, a repeat procedure may have to be undertaken, sometimes after a few years, if further narrowing of the esophagus occurs (presenting swallowing difficulties)

Additional and Relevant Useful Information for Schatzki Ring:

Plummer-Vinson syndrome (PVS) is a rare condition that involves swallowing difficulties due to esophageal webs causing partial obstruction of the food-pipe. The condition also consists of iron-deficiency anemia, inflammation of the tongue (glossitis), and inflammation of the lip (cheilitis).