Q: A couple of years after an upper endoscopy test I was diagnosed with “non-obstructing Schatzki’s ring.” I have also seen it referred to in my medical records as “terminal esophageal web”. I have never heard of this.
I am currently on acid suppression therapy for GERD. I constantly have this feeling of having a lot of phlegm in my throat and am always trying to clear it. Can you tell me more about this? Can it be fixed?
A: Interestingly, almost 15% of patients that have a routine barium swallow are found to have a Schatzki ring which was named after Richard Schatzki, a German-American physician. This ring refers to a narrowing of the lower portion of the esophagus that can cause dysphagia (difficulty swallowing) or even a completely blocked esophagus.
Schatzki rings are the most common structural abnormality known to occur in the esophagus. An esophageal ring is a smooth, thin extension of normal esophageal tissue that consists of three anatomic layers of mucosa, submucosa and muscle. While a Schatzki is a specific type of esophageal ring, the rings are further divided into those above the junction of the esophagus/stomach referred to as A rings and those in the lower junction of the esophagus referred to as B rings. While the cause of the rings is uncertain, it is believed that either acquired or congenital factors may be involved.
Diagnosis is typically made either through a barium swallow or esophagogastroduodenoscopy. An endoscopy will generally show a ring of variable size within the lumen of the esophagus. The ring will often resemble a related entity referred to as an esophageal web that contain additional mucosal tissue but which does not completely encircle the esophagus.
Not all Schatzky rings present symptoms but when they do, swallowing difficulties are common — particularly when an individual attempts to eat solid foods. The food appears to “stick” part way down while attempting to swallow, especially if that food is not chewed well beforehand. The individual is generally able to force the food through or to regurgitate it. Those individuals without actual symptoms seldom worsen over time and will not likely need treatment, while those with symptoms may require esophageal dilation to stretch the area that is narrowed. The duration of the benefit of dilation will vary from person to person but may vary from several months to several years before repeat dilation is required.
Dysphagia that is caused by gastroesophageal reflux disease (GERD) is generally treated with prescription medication taken orally to reduce stomach acid. If this fails to improve things, the next step may ultimately be stretching the esophagus as indicated above, stent insertion, or a Botox injection into the lower esophagus. In the case of those with Parkinson’s, Alzheimer’s or other neurological disorders, patients may be taught new swallowing techniques and exercises. When necessary, surgery for dysphagia may require Nissen fundoplication, (a laparoscopic procedure that involves tightening the lower esophageal sphincter to prevent acid reflux for GERD patients), or laryngeal suspension in which the voice box can be lifted to improve swallowing. Severe cases of dysphagia may require a feeding tube.
On the home front, patients with swallowing issues should avoid caffeine and alcohol, since they can worsen the symptoms of heartburn. They might eating smaller, more frequent meals, cutting solid foods into small pieces to avoid having pieces stick on the way down, and experimenting with different foods to determine which cause more problems than others.
