When Dysphagia Is Not Psychogenic: An Atypical Presentation of Schatzki Ring in a Patient With Schizophrenia

Schatzki rings are benign distal esophageal rings that are often asymptomatic but may cause intermittent solid-food dysphagia or acute food bolus impaction. Symptoms are classically localized to the lower chest; however, atypical throat-localized symptoms may obscure the diagnosis, particularly in patients with psychiatric comorbidity. We report the case of a 74-year-old woman with schizophrenia, gastroesophageal reflux disease, chronic kidney disease stage 3, type 2 diabetes mellitus, hypertension, and hyperlipidemia who presented with three days of globus sensation and progressive inability to swallow. Physical examination revealed salivary pooling without a visible oropharyngeal mass or mucosal lesion. A barium swallow study was attempted but could not be completed because the patient was unable to swallow the contrast. Given concern for esophageal obstruction, esophagogastroduodenoscopy was performed, revealing a 4-5 cm inspissated food bolus impacted at the gastroesophageal junction. The bolus was fragmented with a Roth net and completely removed endoscopically. A Schatzki ring was identified at the gastroesophageal junction and was traversed with moderate resistance. A 3 cm hiatal hernia and mild gastritis were also noted. The patient had complete symptom resolution after endoscopic therapy and was started on pantoprazole and scheduled for outpatient follow-up with interventional gastroenterology for esophageal dilatation. This case highlights the importance of avoiding premature attribution of dysphagia to functional or psychiatric causes. Inability to tolerate oral intake, salivary pooling, and food bolus impaction are obstructive features that should prompt urgent endoscopic evaluation.