The Schatzki ring is said to cause narrowing of the lower esophagus, leading to dysphagia and many other persistent symptoms, but this only applies to a small percentage of patients. In most people, the development of this condition does not cause any symptoms, and its presence is detected during imaging studies.
Narrowing of the esophagus
How is the disease characterized?
Shatsky's ring: what is it? Let's figure it out. It is characterized by thickening of the mucous membrane in the lower part of the esophagus. This narrowing resembles the appearance of a ring. For a long time after the formation of the disease, no symptoms are observed. The first signs appear when the narrowing is 13 mm or more. In this case, swallowing food becomes difficult.
This disease develops in 6% of cases among patients with GERD. In another way, Shatsky's ring is called stenosis or stricture in the area of the transition of the esophagus to the stomach.
Degrees of the disease
This disease is usually divided into 4 degrees of severity, where the main indicator is the level of narrowing of the esophagus and the difficulty of passing food.
First degree
With this type of disease, the patient sometimes has difficulty swallowing solid food, as well as rare, short-term pain in the esophagus and stomach.
Second degree
In this case, the passage of solid food becomes difficult, and the patient can only swallow liquid or semi-liquid foods, such as yogurt, various types of purees, kefir, cream soups, drinks, etc.
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Third degree
Severe narrowing of the esophageal lumen due to Shatsky's ring does not allow almost anything to pass except liquid. Pain in the esophagus and stomach occurs quite often.
Fourth degree
Extreme degree of narrowing. With this pathology, it is impossible for any liquid, including saliva, to pass through the esophagus. Pain in the esophagus is observed constantly.
Factors and reasons for the development of the disease
In the development of the acquired Shatsky ring, factors and causes of formation are identified. Factors include:
- the presence of frequent heartburn ;
- frequent vomiting ;
- the presence of a long period of reflux ;
- burn of the esophagus for various reasons;
- performing surgery on the stomach and esophagus;
- frequent infectious diseases.
Often the cause is the reflux of acidic stomach contents into the esophagus. GERD are at risk . Constant heartburn and vomiting also cause acid to reflux into the esophagus. With constant and prolonged influence of hydrochloric acid on the esophagus, scar changes can form.
Shatsky's ring also applies to congenital diseases. The reasons for the formation of a congenital ring are poorly understood. This is probably due to a disturbance during embryonic development.
General description of the disease
In a healthy person, any liquid or food bolus easily passes through the esophagus from the mouth to the stomach. However, in some people, there is a ring-shaped narrowing at the esophagogastric junction. This process leads to a decrease in the lumen of the organ and makes it difficult for the food bolus to move. Shatsky's rings got their name in honor of the doctor who first described this pathology.
Such a benign formation is found in 4-7% of people. At the same time, no symptoms are observed for a long time or even throughout life. However, stenosis can reach a critical stage, which will cause complaints and lead to a diagnostic search.
The exact cause of this disease has not been established.
At the moment, the reasons for the appearance of Shatsky rings have not been precisely established, however, there are a number of factors that apparently play an important role in this process:
- Gastroesophageal reflux.
- Previous operations on the stomach and esophagus.
- Entry of foreign bodies into the esophagus.
- Burns of the esophagus associated with hot or chemically aggressive liquids.
- Infectious lesion.
- Tumor process in the wall of the esophagus and stomach.
- Radiation exposure or previous radiation therapy.
- Congenital damage to the wall of the esophagus, etc.
In any case, it is not possible to identify one specific cause of the appearance of Shatsky rings, which significantly complicates the treatment of this pathology.
How does the disease develop?
The mechanism of development of acquired narrowing is associated with the formation of scar changes. The presence of reflux ensures a constant flow of acid from the stomach into the esophagus. Hydrochloric acid has a negative effect on the esophageal mucosa. Since it differs from the mucous membrane in the stomach, that is, it is not adapted to constant exposure to acid. For this reason, changes occur in the mucous membrane. Constant inflammation leads to a gradual thickening of the lower esophageal sphincter.
Consequently, prolonged exposure to acid leads to changes in the mucosa such as scarring and thickening. A gradual narrowing occurs, which causes corresponding symptoms.
Why is this disease dangerous?
Shatsky's ring is a disease with a progressive course. The presence of GERD is a condition for further stenosis of the esophagus. Relatively rare diseases. Do not forget about the dangers of such a process. Since the esophagus narrows, the main danger is complete closure of the lumen. Refers to grade 4 stenosis . In this case, there is no way to eat normally. Only surgical treatment is required.
Therefore, when the first symptoms appear, you should consult a gastroenterologist. It is also important to promptly treat GERD and follow a diet.
What are the symptoms?
Symptoms depend on the degree of narrowing of the esophagus. It refers to the organ through which food enters the stomach. Therefore, the first manifestation will be a swallowing disorder. Initially, the passage of harder foods will be difficult. Gradually, a desire arises to give up foods such as bread.
At the same time, there is a feeling of a foreign body behind the sternum. This is due precisely to the disruption of food passage in the sphincter area. It turns out that food simply slows down its passage. As the narrowing progresses, the feeling of discomfort behind the sternum becomes more intense. It occurs only at the time of eating. Patients always try to take plenty of liquid with their meals. This makes the product less hard and easier to pass through. Initially, it is difficult to swallow solid and then liquid food.
Over time, discomfort behind the sternum is replaced by painful sensations.
They are associated with spasm of the muscular structures of the esophagus.
Since stenosis interferes with the evacuation of the food bolus. Therefore, a strong contraction occurs to push food through. This is what causes pain. Characteristic already for the 3rd degree of narrowing . Gradually, against the background of refusal to eat, a body weight deficit develops. Malnutrition is characterized by general weakness and malaise. The risk of developing infectious diseases increases.
Nausea and may occur . Often such symptoms occur after eating. Literally in a matter of minutes after swallowing a bolus of food. These manifestations directly depend on the degree of narrowing. The larger it is, the more often such symptoms will occur.
More information about the symptoms of narrowing of the esophagus is described in this article.
Diagnostic methods
Before starting treatment, it is necessary to find out the exact diagnosis of the disease. To do this, you must undergo a full examination at a medical institution. Today, the most effective methods for diagnosing Shatsky rings are x-ray examination and gastroscopy.
Important! The patient must avoid eating for 8 hours before the start of the diagnostic procedure. Therefore, these examinations are best carried out in the morning on an empty stomach.
X-ray
Before the procedure begins, a special suspension of barium sulfate is injected into the patient’s body, which makes it possible to clearly examine the walls of the esophagus during fluoroscopy. By obtaining a clearer image, the doctor will be able to find the tumor with greater accuracy and make the correct diagnosis.
The fluoroscopy procedure lasts on average 40-50 minutes. After completing the diagnosis, the patient needs to drink a sufficiently large amount of water to ensure rapid removal of barium suspension.
X-ray examination makes it possible to distinguish Shatsky rings from possible accidental protrusion of the walls of the esophagus or various foreign bodies.
Gastroscopy
This examination method is most often used to obtain an accurate visual image of the condition of the esophagus.
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The endoscope is inserted through the oral cavity, followed by video recording of the esophagus on the monitor screen. This allows pathology to be visualized with high image accuracy.
But this method has a significant drawback. The endoscopic tube can pass through the narrowed lumen of the esophagus with considerable difficulty. If there is a very large Shatsky ring in the esophagus, the endoscope tube may not pass through at all.
How to identify Shatsky's ring?
The first thing that helps a doctor diagnose a disease is the symptoms. The process of identifying the disease begins with them.
Research methods are instrumental methods. These include x-rays and FGDS. These two methods are of greatest value for recognizing the disease.
X-ray examination is carried out with a special contrast agent. For these purposes, barium suspension is used. It is important that this method is quite informative. It helps determine the presence of a narrowing. Place of stenosis and degree. Additionally, X-rays evaluate the relief of the mucous membrane of the esophagus and stomach. This method allows a complete assessment of the transit time of barium into the stomach at the site of stenosis. Is important for determining the degree.
FGDS is the second and no less informative method. Thanks to him, the entire education is visually assessed. During the procedure, carefully examine the narrowing itself. The cause and extent are identified. Additionally, the condition of the mucous membrane of the esophagus and stomach is assessed. If necessary, a biopsy may be taken.
Thanks to these methods, the disease is identified and an accurate diagnosis is made.
Diagnostics of Shatsky's ring
to recognize esophageal disease , since the symptoms are nonspecific and resemble a number of other diseases associated with the gastrointestinal tract, for example, esophageal reflux. The only way to differentiate the clinical condition is by radiological examination with contrast or precision gastrointestinal endoscopy or gastroscopy. The patient must be prepared for a visual examination. The day before the operation you should eat light food, and on the day of the operation you should completely avoid eating.
Endoscopic visualization of Shatsky's ring
Gastroscopy is performed under local or general anesthesia if the patient cannot tolerate pain or instruments placed in the mouth. The introduction of an endoscope into the esophagus allows you to accurately assess its internal part and select material for histopathological examination. Another diagnostic method useful in diagnosing Schatzki's ring is X-ray examination using contrast. It is carried out on an empty stomach. A series of images allows you to view the esophagus from different angles.
How is the disease treated?
The treatment process consists of two directions. These include:
- conservative methods;
- surgery.
Among conservative ones, medications and diets are prescribed. The following medications are used for this disease:
- antacids;
- antisecretory;
- gastroprotectors;
- prokinetics;
- antispasmodics;
- sedatives.
If a patient has GERD and often experiences heartburn, he is prescribed medications such as:
- Almagel;
- Omeprazole;
- De-nol;
- Mottilium.
, antispasmodics are used in the form of No-shpa . Its action is aimed at eliminating spasms and reducing pain.
It is recommended to adhere to a strict diet. Since an increase in acidity and its overflow often occurs when an error in eating occurs. Fried and fatty foods should be completely excluded. Excessively salted and seasoned foods are prohibited. All food should be finely chopped and undergo gentle heat treatment. Compliance with diet and drug therapy ensures a minimal level of progression.
Read more about how competent medication and other treatment of the disease should be carried out in this article.
Surgery
It is carried out when there is no effect from the drugs. Bougienage is used for these purposes. The narrowed area is expanded using special bougies. Expansion using a balloon is also used.
In more severe cases, when more extensive surgical care is needed, an operation such as esophageal stenting is performed.
