//fpnotebook.com/
Esophageal Ring
Aka: Esophageal Ring, Esophageal Web, Schatzki Ring, Esophageal A Ring, Esophageal B Ring
- 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 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
- Types: Esophageal Web
- Thin (<2 mm), asymmetric esophageal protrusion into the esophageal lumen, typically in the proximal esophagus
- Associated Conditions
- Plummer-Vinson Syndrome (Iron Deficiency Anemia, Dysphagia, cervical Esophageal Web)
- Zenker's Diverticulum
- Bullous Conditions (Epidermolysis Bullosa, Bullous Pemphigoid, Pemphigus Vulgaris)
- Symptoms
- Dysphagia for solids only
- Diagnosis
- Barium swallow (barium esophagram)
- Upper Endoscopy (EGD)
- Differential Diagnosis
- See Esophageal Dysphagia
- 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)
- References
- Ergon and Kahrilas in Saltzman (2020) Esophageal Rings and Webs, UpToDate, accessed 9/23/2020