Esophageal webs and rings affect the esophagus, the muscular tube connecting the throat to the stomach. These conditions can cause narrowing or constriction of the esophageal lumen, leading to difficulty swallowing and other related symptoms. An esophageal web is a thin, membranous tissue that forms across the inner lining of the esophagus. It typically occurs in the upper part of the esophagus, near the throat. The exact cause of esophageal webs is not well understood, but they are often associated with Plummer-Vinson syndrome.
This syndrome is characterized by the triad of iron deficiency anemia, esophageal webs, and difficulty swallowing. Esophageal webs can also occur due to genetic factors or as a result of other underlying conditions. Esophageal rings, also known as Schatzki rings, are circular bands of tissue that form in the lower part of the esophagus, near the junction with the stomach. These rings are typically composed of fibrous tissue and can cause narrowing of the esophagus, leading to dysphagia.
The exact cause of esophageal rings is not fully understood, but they are often associated with gastroesophageal reflux disease (GERD) and long-term acid reflux. Chronic exposure to stomach acid can lead to scar tissue formation, resulting in the development of esophageal rings. Other factors, such as hiatal hernia and certain genetic predispositions, may also contribute to their formation
Epidemiology
Esophageal webs and rings are relatively rare conditions that affect the esophagus, the muscular tube connecting the throat to the stomach. Esophageal webs and rings are considered uncommon. They are more frequently observed in certain populations and associated with certain risk factors.
Esophageal webs and rings are estimated to affect less than 1% of the general population. They are more commonly seen in certain regions, such as the northern part of Europe, than others. These conditions can occur at any age but are most commonly diagnosed in adults aged 40 to 60. In terms of gender, there is no significant predilection for either males or females.
Anatomy
Pathophysiology
Esophageal webs are thin, membranous structures that form within the lumen of the esophagus, while rings are circular constrictions of the esophageal wall. These abnormalities can cause narrowing of the esophageal lumen, leading to difficulty in swallowing and food impaction. Some researchers believe that esophageal webs and rings are congenital or developmental defects.
It is thought that during embryogenesis, incomplete recanalization of the esophageal lumen may occur, forming webs or rings. Chronic irritation and inflammation of the esophageal lining have also been implicated in developing esophageal webs and rings. Factors such as gastroesophageal reflux disease, which involves the backflow of stomach acid into the esophagus, can lead to chronic inflammation and scarring of the esophageal tissue.
This scarring may contribute to the formation of webs and rings. Certain nutritional deficiencies, particularly iron deficiency anemia, have been associated with the development of esophageal webs and rings, specifically in a condition known as Plummer-Vinson syndrome. The exact mechanisms by which nutritional deficiencies contribute to these abnormalities are not well understood.
However, it is believed that the lack of essential nutrients may impair the normal growth and maintenance of the esophageal lining. Genetic factors may play a role in developing esophageal webs and rings, although the specific genes involved have not been identified. Evidence of familial clustering and increased risk in specific populations suggests a genetic predisposition to these conditions.
Etiology
Chronic iron deficiency anemia is strongly associated with the development of esophageal webs and rings, particularly in Plummer-Vinson syndrome. Iron deficiency can lead to changes in the esophageal epithelium, forming webs or rings. Other nutritional deficiencies, such as deficiencies in vitamins and minerals, have also been implicated in some cases.
Evidence suggests a genetic predisposition to the development of esophageal webs and rings, although the specific genes involved have not been clearly identified. Familial clustering of these conditions has been reported, suggesting a potential hereditary component. Some researchers propose that esophageal webs and rings may arise from developmental defects during embryogenesis. Incomplete recanalization of the esophagus during fetal development could lead to the formation of webs or rings later in life.
Genetics
Prognostic Factors
The prognosis of esophageal webs and rings is generally favorable, as many individuals with these conditions may not experience any symptoms. However, treatment options are available for those with symptoms, such as difficulty swallowing, and esophageal dilatation is a safe and effective approach.
Nevertheless, one of the main challenges in therapy is the relatively high recurrence rate following the dilation of esophageal rings. The risk of recurrence can be reduced by incorporating proton pump inhibitors into the treatment regimen after the dilatation procedure.
Clinical History
Clinical History
Difficulty swallowing is the most common symptom associated with esophageal webs and rings. It typically occurs when the narrowed esophageal lumen caused by the abnormal structures hinders the passage of food and liquids. Dysphagia may be more pronounced for solid foods compared to liquids. Due to the narrowing caused by esophageal webs and rings, there is an increased risk of food becoming lodged in the esophagus, leading to food impaction.
This can cause acute discomfort, pain, and a sensation of a stuck or blocked feeling in the chest. Prolonged or severe dysphagia can lead to unintentional weight loss due to reduced food intake and nutritional deficiencies. In Plummer-Vinson syndrome, which is associated with esophageal webs, individuals may also present with symptoms of iron deficiency anemia, such as fatigue, weakness, and pale skin.
Physical Examination
Physical Examination
The physical findings in a patient with esophageal webs and rings may be variable and can depend on the severity of the condition. Severe cases of esophageal webs and rings, such as in Plummer-Vinson syndrome, can lead to malnutrition and signs of nutritional deficiencies. The examiner may also observe pallor, weakness, or other signs of anemia or nutrient deficiencies.
Prolonged dysphagia and reduced food intake can result in unintentional weight loss. If there is frequent food impaction, it may be associated with difficulty in swallowing saliva, leading to dehydration. Signs of dehydration, such as dry mouth, decreased skin turgor, or low urine output, may be observed.
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Differential Diagnoses
Esophageal Strictures
Achalasia
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Endoscopic esophageal dilatation is the primary initial treatment for symptomatic esophageal webs and rings. The main objective of this treatment is to alleviate dysphagia and prevent the recurrence of symptoms. It is not uncommon for esophageal webs to rupture during a diagnostic esophagogastroduodenoscopy (EGD). In the case of esophageal rings, a biopsy is typically performed before dilatation to exclude the presence of eosinophilic esophagitis.
After the dilatation of esophageal rings, patients often need to undergo therapy with a proton pump inhibitor (PPI), particularly if the rings are located near the gastroesophageal junction. This is done to reduce the risk of symptom recurrence. The major challenge with dilatation as a treatment approach is the relatively high recurrence rate, primarily used to manage esophageal rings.
Repeating esophageal dilation followed by long-term acid suppression with a PPI is a viable treatment option to address recurrent symptomatic esophageal rings. However, if multiple dilatations prove ineffective, alternative therapies can be considered. These may include incisional therapy using techniques such as electrocautery or laser division.
by Stage
by Modality
Chemotherapy
Radiation Therapy
Surgical Interventions
Hormone Therapy
Immunotherapy
Hyperthermia
Photodynamic Therapy
Stem Cell Transplant
Targeted Therapy
Palliative Care
Medication
Future Trends
Media Gallary
References
News
Octopus-Inspired Patches Might Be A Pain-Free Alternative to Injections
Posted on
News
Feminist Cancer Care Approach Aims to Save 800,000 Lives Annually
Posted on
News
Breast Lifts Soar in Popularity Among Women
Posted on
News
Researchers Raise Concern on Alcohol Promotion in Sports
Esophageal webs and rings affect the esophagus, the muscular tube connecting the throat to the stomach. These conditions can cause narrowing or constriction of the esophageal lumen, leading to difficulty swallowing and other related symptoms. An esophageal web is a thin, membranous tissue that forms across the inner lining of the esophagus. It typically occurs in the upper part of the esophagus, near the throat. The exact cause of esophageal webs is not well understood, but they are often associated with Plummer-Vinson syndrome.
This syndrome is characterized by the triad of iron deficiency anemia, esophageal webs, and difficulty swallowing. Esophageal webs can also occur due to genetic factors or as a result of other underlying conditions. Esophageal rings, also known as Schatzki rings, are circular bands of tissue that form in the lower part of the esophagus, near the junction with the stomach. These rings are typically composed of fibrous tissue and can cause narrowing of the esophagus, leading to dysphagia.
The exact cause of esophageal rings is not fully understood, but they are often associated with gastroesophageal reflux disease (GERD) and long-term acid reflux. Chronic exposure to stomach acid can lead to scar tissue formation, resulting in the development of esophageal rings. Other factors, such as hiatal hernia and certain genetic predispositions, may also contribute to their formation
Esophageal webs and rings are relatively rare conditions that affect the esophagus, the muscular tube connecting the throat to the stomach. Esophageal webs and rings are considered uncommon. They are more frequently observed in certain populations and associated with certain risk factors.
Esophageal webs and rings are estimated to affect less than 1% of the general population. They are more commonly seen in certain regions, such as the northern part of Europe, than others. These conditions can occur at any age but are most commonly diagnosed in adults aged 40 to 60. In terms of gender, there is no significant predilection for either males or females.
Esophageal webs are thin, membranous structures that form within the lumen of the esophagus, while rings are circular constrictions of the esophageal wall. These abnormalities can cause narrowing of the esophageal lumen, leading to difficulty in swallowing and food impaction. Some researchers believe that esophageal webs and rings are congenital or developmental defects.
It is thought that during embryogenesis, incomplete recanalization of the esophageal lumen may occur, forming webs or rings. Chronic irritation and inflammation of the esophageal lining have also been implicated in developing esophageal webs and rings. Factors such as gastroesophageal reflux disease, which involves the backflow of stomach acid into the esophagus, can lead to chronic inflammation and scarring of the esophageal tissue.
This scarring may contribute to the formation of webs and rings. Certain nutritional deficiencies, particularly iron deficiency anemia, have been associated with the development of esophageal webs and rings, specifically in a condition known as Plummer-Vinson syndrome. The exact mechanisms by which nutritional deficiencies contribute to these abnormalities are not well understood.
However, it is believed that the lack of essential nutrients may impair the normal growth and maintenance of the esophageal lining. Genetic factors may play a role in developing esophageal webs and rings, although the specific genes involved have not been identified. Evidence of familial clustering and increased risk in specific populations suggests a genetic predisposition to these conditions.
Chronic iron deficiency anemia is strongly associated with the development of esophageal webs and rings, particularly in Plummer-Vinson syndrome. Iron deficiency can lead to changes in the esophageal epithelium, forming webs or rings. Other nutritional deficiencies, such as deficiencies in vitamins and minerals, have also been implicated in some cases.
Evidence suggests a genetic predisposition to the development of esophageal webs and rings, although the specific genes involved have not been clearly identified. Familial clustering of these conditions has been reported, suggesting a potential hereditary component. Some researchers propose that esophageal webs and rings may arise from developmental defects during embryogenesis. Incomplete recanalization of the esophagus during fetal development could lead to the formation of webs or rings later in life.
The prognosis of esophageal webs and rings is generally favorable, as many individuals with these conditions may not experience any symptoms. However, treatment options are available for those with symptoms, such as difficulty swallowing, and esophageal dilatation is a safe and effective approach.
Nevertheless, one of the main challenges in therapy is the relatively high recurrence rate following the dilation of esophageal rings. The risk of recurrence can be reduced by incorporating proton pump inhibitors into the treatment regimen after the dilatation procedure.
Clinical History
Difficulty swallowing is the most common symptom associated with esophageal webs and rings. It typically occurs when the narrowed esophageal lumen caused by the abnormal structures hinders the passage of food and liquids. Dysphagia may be more pronounced for solid foods compared to liquids. Due to the narrowing caused by esophageal webs and rings, there is an increased risk of food becoming lodged in the esophagus, leading to food impaction.
This can cause acute discomfort, pain, and a sensation of a stuck or blocked feeling in the chest. Prolonged or severe dysphagia can lead to unintentional weight loss due to reduced food intake and nutritional deficiencies. In Plummer-Vinson syndrome, which is associated with esophageal webs, individuals may also present with symptoms of iron deficiency anemia, such as fatigue, weakness, and pale skin.
Physical Examination
The physical findings in a patient with esophageal webs and rings may be variable and can depend on the severity of the condition. Severe cases of esophageal webs and rings, such as in Plummer-Vinson syndrome, can lead to malnutrition and signs of nutritional deficiencies. The examiner may also observe pallor, weakness, or other signs of anemia or nutrient deficiencies.
Prolonged dysphagia and reduced food intake can result in unintentional weight loss. If there is frequent food impaction, it may be associated with difficulty in swallowing saliva, leading to dehydration. Signs of dehydration, such as dry mouth, decreased skin turgor, or low urine output, may be observed.
Differential Diagnoses
Esophageal Strictures
Achalasia
Endoscopic esophageal dilatation is the primary initial treatment for symptomatic esophageal webs and rings. The main objective of this treatment is to alleviate dysphagia and prevent the recurrence of symptoms. It is not uncommon for esophageal webs to rupture during a diagnostic esophagogastroduodenoscopy (EGD). In the case of esophageal rings, a biopsy is typically performed before dilatation to exclude the presence of eosinophilic esophagitis.
After the dilatation of esophageal rings, patients often need to undergo therapy with a proton pump inhibitor (PPI), particularly if the rings are located near the gastroesophageal junction. This is done to reduce the risk of symptom recurrence. The major challenge with dilatation as a treatment approach is the relatively high recurrence rate, primarily used to manage esophageal rings.
Repeating esophageal dilation followed by long-term acid suppression with a PPI is a viable treatment option to address recurrent symptomatic esophageal rings. However, if multiple dilatations prove ineffective, alternative therapies can be considered. These may include incisional therapy using techniques such as electrocautery or laser division.
medtigo
Esophageal Webs and Rings
Updated :
June 2, 2023
Esophageal webs and rings affect the esophagus, the muscular tube connecting the throat to the stomach. These conditions can cause narrowing or constriction of the esophageal lumen, leading to difficulty swallowing and other related symptoms. An esophageal web is a thin, membranous tissue that forms across the inner lining of the esophagus. It typically occurs in the upper part of the esophagus, near the throat. The exact cause of esophageal webs is not well understood, but they are often associated with Plummer-Vinson syndrome.
This syndrome is characterized by the triad of iron deficiency anemia, esophageal webs, and difficulty swallowing. Esophageal webs can also occur due to genetic factors or as a result of other underlying conditions. Esophageal rings, also known as Schatzki rings, are circular bands of tissue that form in the lower part of the esophagus, near the junction with the stomach. These rings are typically composed of fibrous tissue and can cause narrowing of the esophagus, leading to dysphagia.
The exact cause of esophageal rings is not fully understood, but they are often associated with gastroesophageal reflux disease (GERD) and long-term acid reflux. Chronic exposure to stomach acid can lead to scar tissue formation, resulting in the development of esophageal rings. Other factors, such as hiatal hernia and certain genetic predispositions, may also contribute to their formation
Esophageal webs and rings are relatively rare conditions that affect the esophagus, the muscular tube connecting the throat to the stomach. Esophageal webs and rings are considered uncommon. They are more frequently observed in certain populations and associated with certain risk factors.
Esophageal webs and rings are estimated to affect less than 1% of the general population. They are more commonly seen in certain regions, such as the northern part of Europe, than others. These conditions can occur at any age but are most commonly diagnosed in adults aged 40 to 60. In terms of gender, there is no significant predilection for either males or females.
Esophageal webs are thin, membranous structures that form within the lumen of the esophagus, while rings are circular constrictions of the esophageal wall. These abnormalities can cause narrowing of the esophageal lumen, leading to difficulty in swallowing and food impaction. Some researchers believe that esophageal webs and rings are congenital or developmental defects.
It is thought that during embryogenesis, incomplete recanalization of the esophageal lumen may occur, forming webs or rings. Chronic irritation and inflammation of the esophageal lining have also been implicated in developing esophageal webs and rings. Factors such as gastroesophageal reflux disease, which involves the backflow of stomach acid into the esophagus, can lead to chronic inflammation and scarring of the esophageal tissue.
This scarring may contribute to the formation of webs and rings. Certain nutritional deficiencies, particularly iron deficiency anemia, have been associated with the development of esophageal webs and rings, specifically in a condition known as Plummer-Vinson syndrome. The exact mechanisms by which nutritional deficiencies contribute to these abnormalities are not well understood.
However, it is believed that the lack of essential nutrients may impair the normal growth and maintenance of the esophageal lining. Genetic factors may play a role in developing esophageal webs and rings, although the specific genes involved have not been identified. Evidence of familial clustering and increased risk in specific populations suggests a genetic predisposition to these conditions.
Chronic iron deficiency anemia is strongly associated with the development of esophageal webs and rings, particularly in Plummer-Vinson syndrome. Iron deficiency can lead to changes in the esophageal epithelium, forming webs or rings. Other nutritional deficiencies, such as deficiencies in vitamins and minerals, have also been implicated in some cases.
Evidence suggests a genetic predisposition to the development of esophageal webs and rings, although the specific genes involved have not been clearly identified. Familial clustering of these conditions has been reported, suggesting a potential hereditary component. Some researchers propose that esophageal webs and rings may arise from developmental defects during embryogenesis. Incomplete recanalization of the esophagus during fetal development could lead to the formation of webs or rings later in life.
The prognosis of esophageal webs and rings is generally favorable, as many individuals with these conditions may not experience any symptoms. However, treatment options are available for those with symptoms, such as difficulty swallowing, and esophageal dilatation is a safe and effective approach.
Nevertheless, one of the main challenges in therapy is the relatively high recurrence rate following the dilation of esophageal rings. The risk of recurrence can be reduced by incorporating proton pump inhibitors into the treatment regimen after the dilatation procedure.
Clinical History
Difficulty swallowing is the most common symptom associated with esophageal webs and rings. It typically occurs when the narrowed esophageal lumen caused by the abnormal structures hinders the passage of food and liquids. Dysphagia may be more pronounced for solid foods compared to liquids. Due to the narrowing caused by esophageal webs and rings, there is an increased risk of food becoming lodged in the esophagus, leading to food impaction.
This can cause acute discomfort, pain, and a sensation of a stuck or blocked feeling in the chest. Prolonged or severe dysphagia can lead to unintentional weight loss due to reduced food intake and nutritional deficiencies. In Plummer-Vinson syndrome, which is associated with esophageal webs, individuals may also present with symptoms of iron deficiency anemia, such as fatigue, weakness, and pale skin.
Physical Examination
The physical findings in a patient with esophageal webs and rings may be variable and can depend on the severity of the condition. Severe cases of esophageal webs and rings, such as in Plummer-Vinson syndrome, can lead to malnutrition and signs of nutritional deficiencies. The examiner may also observe pallor, weakness, or other signs of anemia or nutrient deficiencies.
Prolonged dysphagia and reduced food intake can result in unintentional weight loss. If there is frequent food impaction, it may be associated with difficulty in swallowing saliva, leading to dehydration. Signs of dehydration, such as dry mouth, decreased skin turgor, or low urine output, may be observed.
Differential Diagnoses
Esophageal Strictures
Achalasia
Endoscopic esophageal dilatation is the primary initial treatment for symptomatic esophageal webs and rings. The main objective of this treatment is to alleviate dysphagia and prevent the recurrence of symptoms. It is not uncommon for esophageal webs to rupture during a diagnostic esophagogastroduodenoscopy (EGD). In the case of esophageal rings, a biopsy is typically performed before dilatation to exclude the presence of eosinophilic esophagitis.
After the dilatation of esophageal rings, patients often need to undergo therapy with a proton pump inhibitor (PPI), particularly if the rings are located near the gastroesophageal junction. This is done to reduce the risk of symptom recurrence. The major challenge with dilatation as a treatment approach is the relatively high recurrence rate, primarily used to manage esophageal rings.
Repeating esophageal dilation followed by long-term acid suppression with a PPI is a viable treatment option to address recurrent symptomatic esophageal rings. However, if multiple dilatations prove ineffective, alternative therapies can be considered. These may include incisional therapy using techniques such as electrocautery or laser division.
Free CME credits
Both our subscription plans include Free CME/CPD AMA PRA Category 1 credits.
Digital Certificate PDF
On course completion, you will receive a full-sized presentation quality digital certificate.
medtigo Simulation
A dynamic medical simulation platform designed to train healthcare professionals and students to effectively run code situations through an immersive hands-on experience in a live, interactive 3D environment.
medtigo Points
medtigo points is our unique point redemption system created to award users for interacting on our site. These points can be redeemed for special discounts on the medtigo marketplace as well as towards the membership cost itself.
Community Forum post/reply = 5 points
*Redemption of points can occur only through the medtigo marketplace, courses, or simulation system. Money will not be credited to your bank account. 10 points = $1.
All Your Certificates in One Place
When you have your licenses, certificates and CMEs in one place, it's easier to track your career growth. You can easily share these with hospitals as well, using your medtigo app.
