The digestive system is a complex network of organs that process food for nutrient absorption and waste elimination. The esophagus, a muscular tube, transports chewed food from the throat to the stomach through muscle contractions. The stomach acts as a reservoir, mixing food with digestive acids and enzymes. A specialized muscle, the lower esophageal sphincter, functions as a gateway, relaxing to allow food into the stomach and tightening to prevent backflow.
What is a Hiatal Hernia?
A hiatal hernia occurs when a portion of the stomach protrudes upward through an opening in the diaphragm, known as the esophageal hiatus, and into the chest cavity. This muscular barrier normally separates the chest from the abdomen. This protrusion can lead to various digestive concerns.
The most common form is a sliding hiatal hernia, where the junction between the esophagus and stomach, along with part of the stomach, intermittently slides up and down through the hiatus. It accounts for the majority of hiatal hernias. Less common are paraesophageal hiatal hernias, where a section of the stomach pushes up alongside the esophagus, while the esophageal-stomach junction remains in its usual position.
What is a Schatzki’s Ring?
A Schatzki’s ring is a thin, circular band of tissue that develops in the lower part of the esophagus, precisely where it connects to the stomach. This ring is composed of mucosal tissue and is not cancerous. Its formation results in a narrowing of the esophageal opening.
The presence of a Schatzki’s ring can impede the smooth passage of food and liquids through the esophagus. The extent of narrowing influences symptoms, with smaller rings more likely to cause issues. This tissue structure is commonly found at the transition point between the esophageal and stomach lining.
The Connection Between Them
While a hiatal hernia and a Schatzki’s ring are distinct conditions, they frequently occur together in individuals. The presence of a hiatal hernia can contribute to the development of gastroesophageal reflux disease (GERD). GERD involves the backward flow of stomach acid into the esophagus.
Chronic exposure to stomach acid from GERD can irritate and inflame the esophageal lining. Over time, this repeated irritation can lead to tissue changes and scarring, which can lead to Schatzki’s ring formation. The ring might even be a physiological response by the body to help limit acid exposure.
Recognizing Symptoms and Getting Diagnosed
Individuals with these conditions may experience various symptoms, particularly when the esophageal opening is significantly narrowed. Difficulty swallowing, medically termed dysphagia, is a common complaint, especially when consuming solid foods like dry bread or meat. People might also describe a sensation of food getting stuck in their chest, sometimes referred to as “steakhouse syndrome.” Other symptoms can include heartburn, chest discomfort, regurgitation of food, and, in some instances, unintentional weight loss. Some individuals with these conditions may not experience any symptoms.
Diagnosis typically begins with a review of symptoms and a physical examination. Healthcare providers often utilize a barium swallow, also known as an esophagram, where the patient drinks a barium solution while X-ray images are taken. This allows visualization of the esophagus, revealing narrowing or a hiatal hernia. An upper endoscopy, or esophagogastroduodenoscopy (EGD), involves inserting a flexible tube with a camera into the esophagus and stomach for direct visual inspection. This procedure confirms the diagnosis and enables tissue sample collection for further analysis.
Treatment and Management
Managing a hiatal hernia with a Schatzki’s ring often involves a combination of lifestyle adjustments and medical interventions to alleviate symptoms and prevent complications. Modifying eating habits is often recommended, including chewing food thoroughly, taking smaller bites, and drinking water during meals to aid passage. Avoiding foods known to trigger acid reflux, such as caffeine, chocolate, spicy, and fatty foods, is also beneficial.
To reduce nighttime reflux, elevating the head of the bed and refraining from lying down for at least two to three hours after eating are suggested. Maintaining a healthy weight and managing stress contribute to symptom improvement. Medications, particularly proton pump inhibitors (PPIs) or H2 blockers, are prescribed to decrease stomach acid production and manage GERD.
For the Schatzki’s ring itself, endoscopic dilation is a common, effective treatment. During this procedure, a balloon or specialized dilator is passed through an endoscope to gently stretch or fracture the narrowed ring of tissue. This often provides immediate relief from swallowing difficulties and is combined with acid-suppressing medications to promote healing and reduce recurrence. While dilation is often successful, the ring can sometimes reform, necessitating repeat procedures. For severe or complicated hiatal hernias unresponsive to other treatments, surgical repair to reposition the stomach and reinforce the diaphragm may be considered.