A lower esophageal ring is defined as a narrowing of the esophagus at the squamocolumnar junction.
Lower esophageal rings cause specific symptoms in affected patients, none of which, however, are pathognomonic. Symptoms include dysphagia associated with solid foods and especially bread and meat; the episodes are periodic, do not exacerbate with time and last for a short period of time. Solid foods may be regurgitated or forced down with the aid of a liquid drink. The clinical picture may be complicated with symptoms associated with gastroesophageal reflux disease, such as heartburn.
The first step towards a successful diagnosis is a medical history. Patients tend to report symptoms such as dysphagia to solid foods and prior intake of gastroesophageal reflux-related medication that had no effect. A barium esophagram is used to further illustrate lesions such as webs or rings in the esophagus and an esophageal manometry can help to further evaluate a patient if suspicious findings have been detected. A set of specific criteria has been published for the accurate diagnosis of a lower esophageal ring .
As far as conservative methods are concerned, patients are advised to avoid eating quickly. The primary treatment of lower esophageal rings is the large-bore endoscopic dilation or bougienage, which has evinced excellent results within a short period of time following the procedure. Contraindications for the procedure are bullous disease, Zenker diverticulum, eosinophilic esophagitis and other diseases that increase the risk of perforation.
When dilation is contraindicated, unsuccessful or unavailable, surgical excision, electrocautery and resection with jumbo cold biopsy forceps can be performed . In cases of patients who remain unresponsive to the treatments mentioned above, further evaluation should be sought.
The condition is associated with a good prognosis. Mild narrowing typically causes no symptoms, whereas most of the symptomatic patients are successfully treated with one or more sessions of dilations, rendering surgery a procedure that is rarely employed. No case of death linked to lower esophageal rings has ever been reported.
Lower esophageal rings can occur as an inborn esophageal irregularity or present later in life. Acquired rings can develop as a result of the following conditions:
Lower esophageal rings are frequently illustrated in barium radiographs carried out for other diagnostic purposes at an average rate of 10%     and constitute the predominant cause of intermittent dysphagia associated with solids amongst the adult population . There is, however, inadequate scientific data in order for an accurate prevalence to exist.
The pathogenetic background that underlies lower esophageal rings is not known. Most theories associate the phenomenon with inborn anomalies of esophageal structure, Gastroesophageal reflux disease, temporary shortenings of the esophagus or pill-related inflammation. Some researchers support that there is a connection between the diameter of the lumen and the development of Schatzki rings.
Lower esophageal rings are circular narrowings of the esophagus at its distal part, which is adjacent to the esophagogastric junction. They cause a complete or fractional obstruction of the esophageal lumen and are covered with squamous and/or gastric columnar epithelium.
They are otherwise referred to as Schatzki rings, as they were first described by Schatzki and Gary in 1953 . Lower esophageal rings are diagnosed via a barium esophagram and treated with endoscopic dilation .
The esophagus is an elongated organ that connects the oral cavity with the stomach. It is covered by mucosa and its elasticity allows it to narrow or widen its diameter so that food can easily pass through.
Sometimes, circular strictures appear at the bottom of the esophagus, near its junction to the stomach. These are called lower esophageal rings or Schatzki rings. A person can be born with such an anomaly or develop it due to other conditions.
Schatzki rings cause difficulty in swallowing solid food. They are diagnosed with a barium esophagram and treated with a device that inflates when inserted in the area of the ring, so as to flatten the latter.