II. Types: Esophageal Ring
- Concentric swelling of tissue (2-5 mm) that protrudes into the esophageal lumen
- Typically occurs in the distal Esophagus, at the Lower Esophageal Sphincter (LES)
- Esophageal A Ring
- Esophageal smooth Muscle Contraction at distal Esophagus (proximal to the squamocolumnar junction)
- Esophageal B Ring
- Mucosal swelling in the distal Esophagus (at the squamocolumnar, gastroesophageal junction)
- Schatzki Ring (<12.5 mm diameter) is most common Esophageal B Ring
- Associated with Hiatal Hernia in most cases, as well as Eosinophilic Esophagitis
III. Types: Esophageal Web
- Thin (<2 mm), asymmetric esophageal protrusion into the esophageal lumen
- Extensions of mucosal and submucosal esophageal layers
- Typically in the proximal or middle Esophagus
- Associated Conditions
- Plummer-Vinson Syndrome (Iron Deficiency Anemia, Dysphagia, cervical Esophageal Web)
- Zenkers Diverticulum
- Bullous Conditions (Epidermolysis Bullosa, Bullous Pemphigoid, Pemphigus Vulgaris)
IV. Symptoms
- Dysphagia for solids only
- Food impaction may occur
V. Diagnosis
- Barium swallow (barium esophagram)
- Upper Endoscopy (EGD)
VI. Differential Diagnosis
VII. Management
- Initial approach
- Biopsy Esophageal Rings (exclude Eosinophilic Esophagitis)
- Dilatation of Esophageal Ring
- Proton Pump Inhibitor (e.g. Omeprazole) for 6 weeks after esophageal dilation
- Refractory management
- Various measures under endoscopy have been used (e.g. intralesional Corticosteroid, incision, laser division)
VIII. References
- Ergon and Kahrilas in Saltzman (2020) Esophageal Rings and Webs, UpToDate, accessed 9/23/2020