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Lower Esophageal Ring

(Schatzki Ring; B Ring)

By Kristle Lee Lynch, MD, Assistant Professor of Medicine, Perelman School of Medicine at The University of Pennsylvania

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

The esophagus is the hollow tube that leads from the throat (pharynx) to the stomach.

Some lower esophageal rings may be caused by inflammation of the esophagus due to acid reflux (see Gastroesophageal Reflux Disease (GERD)) or pills that are not completely swallowed (see Erosive Esophagitis).

Normally, the lower esophagus has a diameter of about ¾ inch (about 2 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 (dysphagia) comes and goes and is especially aggravated by meat and dry bread.

Often, the ring is found when doctors look down the esophagus with a flexible tube (endoscopy) to look for reasons why people are having difficulty swallowing. Barium swallow x-rays also show the ring. In this test, people are given barium in a liquid before x-rays are taken. The barium outlines the esophagus, making abnormalities easier to see.

Chewing food thoroughly followed by taking sips of water usually prevents symptoms. A doctor may fix the narrowing by passing an endoscope (a flexible viewing tube) 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, doctors widen the constricting ring by doing a surgical procedure.

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