Esophageal Webs, Rings, & Strictures

These disorders are typically associated with dysphagia but may be asymptomatic. Esophageal webs and rings are thin membranes that grow across the esophagus. We use barium swallow and endoscopy to visualize the membranes. See below for image credits. Plummer Vinson syndrome (aka Paterson-Brown-Kelly syndrome) is characterized by the classic triad of dysphagia, iron-deficient anemia, and upper esophageal web with squamous epithelium on both sides. Patients have increased risk of squamous cell carcinoma of the throat. Researchers are uncertain why esophageal webs form, but it is thought that iron-deficient anemia causes mucositis and membrane formation (because dysphagia sometimes improves with iron supplementation). Thus, we look for signs of iron-deficient anemia – weakness, pallor, glossitis (swollen inflamed tongue), koilonychia (spoon nails), and treat with iron supplements or dilation. Schatzki rings, aka, B rings, appear in the distal esophagus at the squamocolumnar junction. They are thought to be the result of GERD and are always associated with hiatal hernias. Dilation or ring biopsy can open the esophagus to treat dysphagia. Esophageal strictures are abnormal narrowings of the esophageal lumen. There are many causes, but GERD is the most common cause in adults, and ingestion of corrosive substances is the most common cause in children/adolescents. Other causes include esophagitis, drugs, malignancies, and radiation. Treatment includes dilation and addressing the underlying causes (i.e., treating GERD with proton-pump inhibitors). See full tutorial for references.