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Schatzki Ring

What Is It, Causes, Treatment, and More

Author: Alyssa Haag

Editors: Ahaana Singh, Jaclyn Kiser, PA

Copyeditor: Joy Mapes

Illustrator: Abbey Richard


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 canal of the esophagus (i.e., lumen), and eventually may lead to difficulty swallowing, known as dysphagia. The presence of a Schatzki ring in individuals is considered to be the most common cause of episodic solid food dysphagia and food impaction, or blockage of the esophagus by food, in adults. 

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.

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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 typically is nonhereditary -- usually it is not passed down from parents to children. However, the potential underlying causes, such as GERD and Barrett’s esophagus, can be hereditary. 

What are the signs and symptoms of a Schatzki ring?

Oftentimes individuals with a Schatzki ring will be asymptomatic, or without symptoms, particularly if their Schatzki ring is larger than 25 millimeters in diameter. In contrast, if their Schatzki ring is under 13 millimeters in diameter, individuals will almost certainly experience symptoms, like dysphagia. These individuals may also experience heartburn, regurgitation of food, and the sensation that food is stuck in their chest after swallowing. “Steakhouse syndrome” is often associated with a Schatzki ring, occurring when under-chewed meat gets stuck in the esophagus, which causes severe chest pain.  If food impaction occurs, individuals will experience odynophagia, defined as painful swallowing.   

Can a Schatzki ring cause shortness of breath?

A Schatzki ring usually does not cause shortness of breath

How is a Schatzki ring diagnosed?

Diagnosis of a Schatzki ring requires a thorough discussion of the individual’s symptoms with a physician. If the physician suspects narrowing of the esophagus, a barium swallow may be performed, during which the individual is asked to swallow barium contrast. The barium contrast will line the esophagus and appear in an X-ray, so a physician can then use the X-ray images to see and diagnose a Schatzki ring. Evaluation of the ring via a gastroesophageal endoscopy is often the next step. A gastroesophageal endoscopy is a procedure in which a camera attached to the end of a flexible tube is inserted into an individual’s esophagus in order to look for a Schatzki ring or other structure that may be causing dysphagia. 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 in order to facilitate the passage of food and to reduce associated symptoms. In order to do so, the diameter of the ring must be widened through balloon dilation or, in rare cases, with surgery. Balloon dilation is a procedure in which an endoscopic tube attached to a balloon is inserted into the esophagus. Additionally, if acid reflux is believed to be associated with the formation of the 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 due to a ring of tissue that forms in the lower esophagus, which can result in difficulty swallowing. The exact cause of a Schatzki ring is unknown; however, scientists and doctors believe that hiatal hernias, GERD, and Barrett's esophagus may all be associated. While most individuals who have a Schatzki ring are asymptomatic, those who have symptoms usually experience difficulty swallowing, the sensation that food is stuck in their chest after swallowing, heartburn, and regurgitation of food. Diagnosis involves a thorough discussion of symptoms and additional testing if necessary. Treatment is aimed at widening the diameter of the Schatzki ring and can include balloon dilation. If acid reflux is also present, the use of proton pump inhibitor medications may be indicated.  

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Related links

Barrett esophagus
Gastroesophageal reflux disease (GERD): Clinical practice
Hernias: Clinical practice

Resources for research and reference

Mayo Clinic staff. (2020, April 15). Hiatal hernia. In Mayo Clinic: Diseases and conditions. Retrieved January 21, 2021, from https://www.mayoclinic.org/diseases-conditions/hiatal-hernia/symptoms-causes/syc-20373379  

Smith, M. (2010). Diagnosis and management of esophageal rings and webs. Gastroenterology & Hepatology, 6(11): 701–704.

Watts, L., & Patel, K. (2020, September 8). Schatzki ring. In StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK519022/