Esophagus
Esophageal Ring
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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 Condition
s (
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
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