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(See also Overview of Esophageal and Swallowing Disorders.)

The etiology of lower esophageal rings is controversial; the leading theories are that they are congenital or are caused by acid reflux or pill-induced esophagitis.

These rings cause intermittent dysphagia for solids. Symptoms can begin at any age but usually do 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.

Typically, evaluation of dysphagia begins with upper endoscopy, which should show a ring large enough to cause symptoms. If the distal esophagus is adequately distended, barium radiographs usually also show the ring.

Esophageal Ring

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Esophageal rings (also called Schatzki rings) are smooth, concentric, mucosal folds that narrow the esophagus at the esophogastric junction. A hiatus hernia can be seen through the lumen of this ring.

Image provided by David M. Martin, MD.

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This image shows a Schatzki ring (arrow).

© Springer Science+Business Media

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.