What is the etiology of an esophageal ring?

From the Guidelines

Esophageal rings, particularly Schatzki's ring, are primarily associated with gastroesophageal reflux disease (GERD) and eosinophilic esophagitis, which contribute to their development through chronic inflammation and fibrosis. The etiology of esophageal rings is multifactorial, involving both congenital and acquired factors. Key contributing factors include:

• Gastroesophageal reflux disease (GERD), which leads to chronic acid exposure, inflammation, and scarring at the gastroesophageal junction 1
• Eosinophilic esophagitis, characterized by eosinophilic infiltration, tissue damage, and fibrosis, particularly in younger patients 1
• Potential congenital components, developing during embryonic formation of the esophagus
• Chronic pill-induced esophagitis from medications causing local irritation
• Ingestion of caustic substances damaging the esophageal mucosa Patients with esophageal rings often present with intermittent dysphagia, particularly to solid foods, and may require endoscopic dilation if symptoms are significant or persistent despite acid suppression therapy with proton pump inhibitors (PPIs) 1. The management of symptomatic Schatzki's ring involves a single dilatation session to a relatively large diameter (16–20 mm) and the offer of PPI therapy after dilatation to reduce the risk of relapse 1. Consideration should also be given to electrosurgical incision as an effective alternative treatment to oesophageal dilatation for relieving dysphagia related to Schatzki’s ring 1. It is essential to exclude eosinophilic oesophagitis by distal, mid, and proximal oesophageal biopsies in symptomatic Schatzki’s ring 1. PPI therapy is recommended for patients with GERD and dysphagia, as it reduces the need for oesophageal dilatation 1. Overall, the approach to esophageal rings should prioritize the management of underlying conditions like GERD and eosinophilic esophagitis, alongside the consideration of endoscopic interventions for symptomatic relief.

From the Research

Esophageal Ring Etiology

• The etiology of esophageal rings is a topic of interest in the field of gastroenterology, with various studies suggesting different causes.
• According to a study published in 2001 2, the ringed esophagus is an acquired condition with gastroesophageal reflux disease (GERD) as its etiology.
• The study found that all 11 patients with available histology had basal cell hyperplasia, papillomatosis, and an increased number of intraepithelial eosinophils, which are characteristic features of GERD.
• Another study published in 2007 3 found that patients with Schatzki's ring who had GERD were less likely to experience a recurrence of the ring after dilation, suggesting that GERD plays a role in the development of esophageal rings.
• A case report published in 2000 4 described a patient with multiple esophageal rings and histological evidence of eosinophilic esophagitis, which responded to an elimination diet, suggesting that eosinophilic esophagitis may also be a cause of esophageal rings.
• A study published in 2011 5 found that Schatzki rings are frequently associated with additional esophageal disorders, such as sliding hiatal hernia, erosive reflux esophagitis, and esophageal webs, which supports the assumption of a multifactorial etiology.

Possible Causes of Esophageal Rings

• GERD: studies have shown that GERD is a common cause of esophageal rings, particularly in patients with Schatzki's ring 2, 3.
• Eosinophilic esophagitis: a case report published in 2000 4 suggested that eosinophilic esophagitis may be a cause of esophageal rings.
• Multifactorial etiology: a study published in 2011 5 found that Schatzki rings are frequently associated with additional esophageal disorders, which supports the assumption of a multifactorial etiology.
• Other possible causes: other studies have suggested that esophageal rings may be caused by a variety of factors, including congenital conditions, trauma, and inflammation 6.