Schatzki's Ring Explained: Causes, Complications, and Recovery

Medically Reviewed By Alana Biggers, M.D., MPH
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A Schatzki’s ring is a thin ring of tissue that forms around the lower part of the esophagus above the stomach. It gets its name from Richard Schatzki, the doctor who discovered it. A Schatzki’s ring can narrow the esophagus, making it difficult to swallow food, drinks, or medications. If necessary, treatment could include medication or dilation to expand the esophagus.

Read on to learn about Schatzki’s ring symptoms, causes, treatment options, and frequently asked questions.

What is a Schatzki’s ring? 

An illustration of a Schatzki ring, which is extra tissue that forms in the esophagus.
An illustration of a Schatzki ring, which is extra tissue that forms in the esophagus. Illustration by Maya Chastain.

A Schatzki’s ring, Schatzki ring, or B ring, is a thin band of tissue that develops around the base of the esophagus — the tube connecting the mouth and the stomach. The ring can narrow the esophagus, leading to difficulty swallowing food and other items.

If the ring remains 25 millimeters (mm) or larger, it likely will not cause symptoms. However, a Schatzki’s ring less than 13 mm wide will cause symptoms. 

People with a hiatal hernia often have a Schatzki’s ring.

What causes a Schatzki’s ring?

Although there are no known direct causes for Schatzki’s rings, there are some theories. Doctors discover a Schatzki’s ring in around 6–14% of routine X-rays.

Gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD), or acid reflux, occurs when acidic stomach contents flow back up the esophagus. This can lead to inflammation and damage to the esophageal lining.

A Schatzki’s ring may develop due to frequent acid exposure. It could be the body’s way of preventing Barrett’s esophagus, wherein tissue similar to the intestinal lining replaces the typical tissue of the esophagus.

Hiatal hernia

A hiatal hernia develops when the top portion of the stomach moves from its regular position and pushes into the esophagus. This can cause acid reflux when the stomach contents back up into the esophagus.

Eosinophilic esophagitis

Eosinophilic esophagitis (EoE) is an immune system condition that causes chronic inflammation in the esophagus.

EoE and Schatzki’s ring may occur together. However, research shows they occur independently and without a significant connection between the two.

Plummer-Vinson syndrome

Plummer-Vinson syndrome is a rare condition that develops due to untreated, severe iron deficiency anemia. One symptom of this condition is the creation of esophageal webs around the top of the esophagus. These webs can lead to a Schatzki’s ring.

What are the symptoms of a Schatzki’s ring?

Thick Schatzki’s rings that reduce the esophagus to at least 13 mm across can cause:

  • difficulty swallowing food or medication
  • food regurgitation
  • heartburn
  • chest pain after swallowing food

Find out what to do for heartburn.

How do doctors diagnose a Schatzki’s ring?

Doctors use the following tests and procedures to evaluate difficulty swallowing and Schatzki’s rings, among several other conditions:

  • Barium swallow study: For this test, you drink a chalky liquid. Doctors observe the liquid on X-rays as it moves down your throat and esophagus.
  • Upper gastrointestinal endoscopy: For this test, your doctor inserts a thin, flexible tube and camera into your throat. This allows them to see the lining of your esophagus.
  • Biopsy: Your doctor may take a sample of your esophagus lining, including the ring, to look at the cells in a laboratory.

You may have these procedures to diagnose Schatzki’s ring. They can also help rule out other possible causes of your symptoms, such as cancer and Barrett’s esophagus. Barrett’s esophagus is the presence of irregular cells in the esophagus that may develop into a rare type of esophageal cancer.

What are the treatments for a Schatzki’s ring?

Treatment may not be necessary for a Schatzki’s ring that is not causing symptoms. Treatment options for a symptomatic Schatzki’s ring include medication, procedures to expand the ring, and dietary changes.

Medication

Your clinician may prescribe a proton pump inhibitor to help reduce the amount of stomach acid. This can reduce acid reflux and other symptoms, such as heartburn.

Dilation

Dilation can expand or break apart the Schatzki’s ring to widen the esophagus. Your doctor could use bougies or pneumonic balloons. A bougie is a thin plastic tube that, along with an endoscope, goes into your esophagus to widen it. Doctors insert a pneumonic balloon into the endoscopic tube and inflate it to widen the esophagus.

Dietary changes

Changing the way you eat can help alleviate Schatzki’s ring symptoms. This includes:

  • thoroughly chewing food before swallowing
  • eating small portions
  • avoiding foods that are tough, hard to chew, and hard to swallow

Get other tips for difficulty swallowing and when to see a doctor.

What is the outlook?

Treatment can be effective in reducing symptoms of a Schatzki’s ring. However, up to 64% of people have a recurrence within the first 2 years of initial treatment. As such, more dilation procedures may be necessary to manage symptoms.

Other frequently asked questions

Alana Biggers, M.D., MPH, reviewed the following frequently asked questions.

Can a Schatzki’s ring go away?

A Schatzki’s ring typically does not go away on its own. If it becomes symptomatic, it will require treatment to go away. Treatment typically involves medication, dilation, or both.

How common is Schatzki’s ring?

No known population studies exist to document how common Schatzki’s ring is. However, if you have acid reflux or a hiatal hernia, you could be more likely to develop a Schatzki’s ring.

Summary

A Schatzki’s ring develops when the esophagus lining builds up in a specific area, typically at the lower end of the esophagus near the stomach. The exact cause is unknown. However, it may be related to a hiatal hernia.

There are no symptoms with a Schatzki’s ring unless it drastically narrows the esophagus, making swallowing difficult. If this occurs, contact a medical professional for a physical examination and diagnosis. Symptomatic Schatzki’s rings typically go away with treatment but may return in some people.

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Medical Reviewer: Alana Biggers, M.D., MPH
Last Review Date: 2022 Aug 29
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Barrett’s esophagus. (n.d.). https://www.niddk.nih.gov/health-information/digestive-diseases/barretts-esophagus
  2. Ghazaleh, S., et al. (2022). Esophageal webs and rings. https://www.ncbi.nlm.nih.gov/books/NBK539771/
  3. Plummer Vinson syndrome. (2021). https://rarediseases.info.nih.gov/diseases/8259/paterson-kelly-syndrome
  4. Sarbinowska, J., et al. (2021). Association between Schatzki ring and eosinophilic esophagitis: A systematic review and meta-analysis [Abstract]. https://pubmed.ncbi.nlm.nih.gov/33470703/
  5. Watts, L. D., et al. (2021). Schatzki ring. https://www.ncbi.nlm.nih.gov/books/NBK519022/