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Lower Esophageal Ring

(Schatzki Ring; B Ring)

by Michael C. DiMarino, MD

A lower esophageal ring is a 2- to 4-mm mucosal stricture, probably congenital, causing a ringlike narrowing of the distal esophagus at the squamocolumnar junction.

These rings cause intermittent dysphagia for solids (see Dysphagia). 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. Symptoms usually occur only when the esophageal lumen is < 12 mm in diameter and never when it is > 20 mm. If the distal esophagus is adequately distended, barium x‑rays usually show the ring. Instructing the patient to chew food thoroughly is usually the only treatment required in wider rings, but narrow-lumen rings require dilation by endoscopy or bougienage. Surgical resection is rarely required.

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