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Lower Esophageal Ring

(Schatzki Ring; B Ring)

By Michael C. DiMarino, MD, Division of Gastroenterology and Hepatology, Department of Medicine, Thomas Jefferson University

A lower esophageal ring narrows the lower esophagus and is most likely present at birth.

Normally, the lower esophagus has a diameter of 1½ to 2 inches (about 3½ to 5 centimeters). However, it may be narrowed to ½ inch in diameter (about 1¼ centimeters) or less by a ring of tight tissue, which may cause difficulty in swallowing solids. This symptom can begin at any age but usually does not begin until after age 25. The swallowing difficulty comes and goes and is especially aggravated by meat and dry bread. Often, barium swallow x-rays (see X-Ray Studies) are done to show the ring.

Chewing food thoroughly followed bytaking sips of water usually prevents symptoms. A doctor may fix the narrowing by passing an endoscope (a flexible viewing tube—see Endoscopy) through the mouth and throat and into the esophagus or may use a blunt-tipped instrument (called a bougie) to widen the passageway. In rare cases, the constricting ring is opened via a surgical procedure.

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