Trouble Swallowing? It Could Be a Schatzki Ring

You are sitting at a restaurant enjoying a steak dinner when suddenly the bite you just took refuses to go down your throat. It feels stuck in your chest, causing panic and discomfort. At INTEGRIS Health, we occasionally treat patients who are surprised to find out their Schatzki ring symptoms are not just the result of eating too fast, but a sign of a real medical condition. 

This narrowing of the lower esophagus is a common cause of swallowing difficulties, yet many people live with it for years before seeking help. Understanding what causes this restriction and how to treat it can turn mealtime back into a source of enjoyment rather than anxiety.

We speak to Neal Kaushal, M.D., MBA, a board-certified gastroenterologist at INTEGRIS Health Medical Group Gastroenterology Edmond, to learn more. 

“Since swallowing difficulties can be caused by various issues ranging from strictures to tumors, proper diagnosis is essential,” Kaushal says. “If you’re experiencing symptoms like trouble swallowing, speak to your doctor or consult a gastroenterologist for diagnosis and treatment.” 

What is a Schatzki ring?

What to know: A Schatzki ring is a smooth, thin band of tissue that forms in the lower part of the esophagus. It creates a narrowing of the passage that carries food from your mouth to your stomach, acting like a bottleneck. While many people have these rings without realizing it, the narrowing can become severe enough to obstruct the passage of solid food.

• This tissue band is mucosal and typically forms just above the junction of the stomach and esophagus.
• It is considered the most common cause of intermittent dysphagia (difficulty swallowing) with solid foods in adults.
• The ring is usually benign and not an indicator of esophageal cancer.

The prevalence of this condition is surprisingly high among the general population.

• Estimates suggest that anywhere from 6 to 14% of people may have a Schatzki ring.
• Most people will remain asymptomatic throughout their lives.
• Symptoms typically do not appear until the opening of the esophagus narrows to less than 13 millimeters.

How Schatzki rings are connected to hiatal hernias

Key points: There is a distinct anatomical link between the presence of a Schatzki ring and hiatal hernias. In the vast majority of cases, patients diagnosed with a symptomatic ring are also found to have a hiatal hernia during examination. This suggests that the displacement of the stomach may play a role in the development of the ring.

• A hiatal hernia occurs when the upper part of the stomach pushes up through the diaphragm into the chest cavity.
• This displacement changes the anatomy of the gastroesophageal junction.
• The condition is often identified during the same diagnostic tests used for swallowing issues.

Acid reflux plays a major role in why these two conditions often appear together.

• Hiatal hernias often contribute to gastroesophageal reflux disease (GERD).
• Chronic exposure to stomach acid in the lower esophagus can cause inflammation and scarring.
• Doctors believe this repetitive healing process may lead to the formation of the fibrous ring tissue.

Recognizing the symptoms of a Schatzki ring

The basics: Many people with a Schatzki ring have no idea it is there until they experience a blockage. The defining characteristic of Schatzki ring symptoms is that they are usually intermittent. You might eat breakfast and lunch with no issues, only to have trouble with dinner.

• Difficulty swallowing solid foods is the primary complaint.
• Liquids usually pass through without any problem.
• The sensation of sticking is often felt in the lower neck or directly behind the breastbone.

Steakhouse syndrome is a colloquial term often used to describe the acute onset of symptoms.

• This refers to an episode where a large bolus of meat becomes impacted in the esophagus.
• It typically happens when eating tough meats that have not been chewed thoroughly.
• The obstruction can cause chest pain and the inability to swallow saliva until it passes or is removed.

Regurgitation may occur if the food does not pass into the stomach on its own.

• Some patients may induce vomiting to relieve the pressure and pain in the chest.
• Forcing the food down by drinking water works in mild cases but can worsen the pain in severe impactions.
• Recurring episodes often lead patients to modify their eating habits subconsciously.

How Schatzki rings are diagnosed

Why it matters: Your health care provider will need to visualize the interior of the esophagus to rule out other causes and confirm the presence of the ring.

• A barium swallow test can let your doctor obtain imaging of your esophagus.
• An upper endoscopy can give a direct assessment of your esophageal lining.
• Your complete medical history should also be considered to rule out alternative causes.

A barium swallow test is a common, non-invasive diagnostic tool. This method can give imaging that shows the presence and, to some extent, the severity of a Schatzki ring. 

• You swallow a liquid barium solution that coats the esophagus, making it visible on an X-ray.
• Doctors look for a distinct indentation or narrowing near the stomach junction.

An upper endoscopy provides a more direct way to evaluate the esophageal lining.

• This procedure involves passing a flexible tube with a camera down the throat.
• It allows the doctor to see the texture and size of the ring directly.
• It also allows the physician to check for signs of GERD or Barrett’s esophagus.

Medical history is just as important as the physical exams.

• Your doctor will ask about the frequency of your symptoms.
• They will want to know if the sticking sensation happens with solids, liquids or both.
• Knowing if you have a history of heartburn helps connect the dots.

Treatment options for Schatzki rings

Your options: The approach to Schatzki ring management and treatment focuses on mechanical relief. Since the problem is a physical narrowing, the most effective solution is to physically widen the opening. This is a highly successful treatment that offers immediate relief for most patients.

• Esophageal dilation is the standard procedure used to stretch the ring.
• During an endoscopy, a balloon or tapered dilator is passed through the narrowed area.
• The force fractures the ring tissue, expanding the diameter of the esophagus.

Long-term management is necessary because the rings can recur over time.

• Studies show that up to 64% of patients may experience a recurrence within two years.
• Repeat dilation is a safe and effective option if symptoms return.
• Patients are often placed on acid-suppressing medications like proton pump inhibitors.

Controlling acid reflux is a critical part of the treatment plan to prevent the ring from coming back.

• Reducing acid exposure helps heal the esophageal inflammation.
• This addresses the likely underlying cause of the tissue formation.
• Consistent use of medication has been shown to reduce the need for repeat dilation.

Find a doctor at INTEGRIS Health now

Next steps: The anxiety of wondering if your next meal will get stuck can take the joy out of eating. If you’re experiencing difficulty swallowing or suspect a Schatzki ring, find a doctor at INTEGRIS Health to explore your options for diagnosis and treatment.

This article was medically reviewed by Neal Kaushal, M.D., MBA. Our health and wellness experts regularly review new research and update our articles to reflect the most current, evidence-based information.

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