From the Guidelines
Schatzi ring is primarily caused by chronic gastroesophageal reflux disease (GERD), which leads to the formation of a thin, circumferential mucosal fold or ring near the gastroesophageal junction, as supported by the study published in Gut in 2018 1. The development of Schatzi ring is a complex process involving chronic inflammation and irritation of the esophageal lining due to stomach acid reflux. Key factors contributing to the formation of Schatzi ring include:
- Chronic gastroesophageal reflux disease (GERD)
- Hiatal hernia, which alters the normal anatomy of the esophagus-stomach junction and increases reflux risk
- Genetic predisposition, with a possible familial tendency
- Age, with Schatzi rings being more common in middle-aged and older adults The ring forms as a protective response to chronic acid exposure, representing the body's attempt to create a barrier against further damage. However, this adaptation can lead to symptoms like dysphagia (difficulty swallowing), particularly with solid foods, when the ring narrows the esophageal lumen significantly, as noted in the study published in the Journal of the American College of Radiology in 2019 1. It is essential to consider these factors when evaluating and managing patients with Schatzi ring, prioritizing morbidity, mortality, and quality of life as the primary outcomes. The study published in Gut in 2018 1 provides robust evidence for the efficacy of a single dilatation to 16–20 mm in relieving dysphagia due to Schatzi’s ring, and long-term PPI therapy significantly reduces the risk of relapse compared with placebo. Therefore, management of Schatzi ring should focus on addressing the underlying cause of GERD, and treatment options like dilatation and PPI therapy should be considered to alleviate symptoms and improve quality of life.
From the Research
Causes of Schatzki Ring
- The exact cause of Schatzki ring is not clear, but it may be related to gastroesophageal reflux disease (GERD) 2, 3.
- The ring is believed to be produced by an infolding at the junction between the squamous and columnar mucosa 2.
- Hiatal hernias are also associated with Schatzki's ring 2.
- Pill injury may worsen the dysphagia associated with Schatzki's ring 2.
Pathogenesis
- The pathogenesis of Schatzki's ring is not well understood, but it is thought to be distinct from strictures caused by gastroesophageal reflux disease 4.
- Schatzki rings are sharply localized lesions with clearly defined margins, whereas peptic strictures have a more gradual transition between normal and abnormal esophagus 4.