Schatzki Ring · What Is It, Causes, Treatment, and More

Published: Nov 04, 2025

Author: Alyssa Haag, MD•

Editor: Ahaana Singh•

Editor: Jaclyn Kiser, PA•

Editor: Anna Hernández, MD

Illustrator: Abbey Richard, MSc•

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What is a Schatzki ring?

A Schatzki ring, first identified in 1944 by Dr. Richard Schatzki, is a thin, circular membrane of tissue that forms in the lower esophagus, the tube that connects an individual's mouth to their stomach. A Schatzki ring causes narrowing of the lumen of the esophagus and eventually may lead to difficulty swallowing, known as dysphagia. The presence of a Schatzki ring is considered to be the most common cause of episodic solid food dysphagia and food impaction in adults.

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What is a hiatal hernia with a Schatzki ring?

Almost all Schatzki rings are associated with hiatal hernias, which occur when part of the stomach moves from where it normally resides in the abdomen and enters the chest cavity. The most common type is a sliding hiatal hernia, or type 1, which can result in irritation of the esophagus due to the rise of acidic stomach contents. Chronic irritation of the esophagus from a gastric reflux related to a sliding hiatal hernia may result in the formation of a Schatzki ring.

What is the cause of a Schatzki ring?

While the exact cause of a Schatzki ring is unclear, potential causes include hiatal hernias, acid reflux, and a condition called Barrett’s esophagus. Acid reflux, also called gastroesophageal reflux disease (GERD), occurs when the acidic contents of the stomach enter the esophagus and cause irritation, which can induce heartburn. Prolonged irritation of the esophagus due to acid reflux may result in Schatzki ring formation. Barrett’s esophagus is a complication of GERD and involves permanent changes to the lining of the esophagus, which may also lead to the formation of a Schatzki ring.

Is a Schatzki ring hereditary?

A Schatzki ring is not hereditary, meaning it is not passed down from parents to children. However, the potential underlying causes, such as GERD and Barrett’s esophagus, can have a genetic predisposition.

What are the signs and symptoms of a Schatzki ring?

Oftentimes, individuals with a Schatzki ring are asymptomatic, particularly if the Schatzki ring is larger than 25 millimeters in diameter. In contrast, if the Schatzki ring is under 13 millimeters in diameter, individuals will almost certainly experience symptoms, as there’s less space for food to pass through the esophagus. Common symptoms include difficulty swallowing, or dysphagia, especially with dry or fibrous foods like meat or bread. Food may become lodged above the ring, causing a sensation of a “lump” or blockage in the esophagus as well as chest discomfort. Symptoms may become worse when food is not chewed properly or when eating quickly, increasing the risk of food impaction. Unlike other causes of dysphagia, like esophageal cancer, difficulty swallowing occurs almost exclusively with solid foods and is not progressive.

How is a Schatzki ring diagnosed?

Diagnosis of a Schatzki ring is suspected based on a review of the signs and symptoms. If the clinician suspects narrowing of the esophagus, a barium swallow test may be performed, during which the individual is asked to swallow barium contrast to outline the esophagus in an X-ray. If a Schatzki ring is present, the barium swallow will show a thin, smooth constriction at the end of the esophagus.

Often, diagnostic work-up also includes an upper endoscopy (EGD) which can rule out other causes of dysphagia and assess esophageal damage from acid reflux. In cases of severe reflex disease, a biopsy may also be required to determine the presence of Barrett’s esophagus.

How is a Schatzki ring treated?

If symptomatic, a Schatzki ring can be treated to facilitate the passage of food and reduce associated symptoms. To do so, the diameter of the ring is widened through balloon dilation or, in rare cases, with surgery. Balloon dilation is a procedure in which an endoscopic tube attached to an inflatable balloon is inserted into the esophagus. Once the balloon is positioned across the Schatzki ring, it is slowly inflated with air or water to widen the mucosal band allowing food to pass more easily. Even though balloon dilation has a high success rate to relieve dysphagia, recurrence is common when acid reflux is not controlled, so repeat dilation may be needed in some cases. In cases where acid reflux is believed to be associated with Schatzki ring, acid reducing medications known as proton pump inhibitors (e.g., omeprazole) can be used to reduce symptoms.

What are the most important facts to know about a Schatzki ring?

A Schatzki ring is a narrowing of the lumen of the esophagus caused by a ring of mucosal tissue. While the exact cause is unknown, it may be a protective adaptation to acid exposure in cases of acid reflux disease. Most individuals with a Schatzki ring are asymptomatic, but those with symptoms may have trouble swallowing, especially solid foods; and may have episodes of food impaction. Diagnosis may involve a barium swallow test and upper endoscopy to rule out other causes of dysphagia. Treatment is aimed at widening the diameter of the Schatzki ring through balloon dilation. If acid reflux is also present, the use of proton pump inhibitor medications may be indicated.

Key Takeaways

Definition	A Schatzki ring is a thin, circular membrane of tissue that forms in the lower esophagus, causing narrowing of its lumen and eventually may lead to difficulty swallowing. It is the most common cause of episodic food dysphagia and food impaction in adults.
Hiatal Hernia with a Schatzki Ring	- Hiatal hernia = part of the stomach moves from abdomen into the chest cavity - Most common: sliding hiatal hernia - Causes chronic irritation of esophagus from gastric acid reflux → formation of a Schatzki ring
Causes	- Hiatal hernias - Acid reflux, or gastroesophageal reflux disease (GERD) - Barrett's esophagus
Heredity	- Not hereditary - Genetic predisposition of underlying causes (GERD, Barrett’s esophagus)
Signs and Symptoms	- Often asymptomatic (especially if diameter larger than 25 mm) - Diameter smaller than 13 mm → symptoms - Difficulty swallowing (dysphagia) - Only with solid foods, not progressive - Lump sensation and chest discomfort - Worsened when not chewed properly or eating quickly
Treatment	- Balloon dilation - Recurrence common when reflux not controlled → repeat dilation may be needed - Acid reducing medications (proton pump inhibitors)

References

Floch MH. Netter’s Gastroenterology. 3rd ed. (Pitchumoni CS, Floch NR, Rosenthal R, Scolapio J, Lim JK, eds.). Elsevier - Health Sciences Division; 2019.

Kamboj AK, Dilmaghani S, Schueler BA, Barlow JM, Katzka DA. Defining the long-term clinical course and need for repeat dilation for patients with schatzki rings. Clin Gastroenterol Hepatol. 2022;20(3):709-711.e2. doi:10.1016/j.cgh.2021.03.040

Liu LWC, Andrews CN, Armstrong D, et al. Clinical practice guidelines for the assessment of uninvestigated esophageal dysphagia. J Can Assoc Gastroenterol. 2018;1(1):5-19. doi:10.1093/jcag/gwx008

Wilkinson JM, Codipilly DC, Wilfahrt RP. Dysphagia: Evaluation and collaborative management. Am Fam Physician. 2021;103(2):97-106. Accessed May 1, 2025. https://www.aafp.org/pubs/afp/issues/2021/0115/p97.pdf