Esophageal rings and webs
- Gulchin A Ergun, MD
Gulchin A Ergun, MD
- Associate Professor of Medicine
- Baylor College of Medicine
- Peter J Kahrilas, MD
Peter J Kahrilas, MD
- Professor of Medicine
- Feinberg School of Medicine, Northwestern University
Esophageal rings and webs are thin, typically delicate structures that partially or completely occlude the esophageal lumen. Patients with esophageal rings or webs typically present with dysphagia to solids. The majority of esophageal rings and webs can be treated endoscopically.
The pathogenesis, clinical manifestations, diagnosis, and treatment of esophageal rings and webs will be reviewed here, with a focus on Schatzki rings. The approach to patients with dysphagia and esophageal strictures is discussed elsewhere. (See "Overview of dysphagia in adults" and "Management of benign esophageal strictures".)
Esophageal ring — Esophageal rings are found in the distal esophagus. Typically, they are mucosal structures, though rarely, muscular rings are seen. Schatzki rings (a subset of B rings) are the most common type of esophageal ring.
Esophageal rings are most clearly identified on barium esophagram :
●A ring – Muscular ring located in the distal esophagus just proximal to the squamocolumnar junction corresponding to the strongest part of the lower esophageal sphincter. Hence, an A ring is caused by normal smooth muscle contraction in the esophagus. When hypertrophic, an A ring is called a muscular ring. These are rare and are usually seen in children. The caliber of a muscular ring changes during peristalsis, distinguishing it from a peptic stricture or mucosal ring.
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- Esophageal ring
- Esophageal web
- PATHOGENESIS AND ASSOCIATED CONDITIONS
- Esophageal rings
- Esophageal webs
- Plummer-Vinson syndrome
- CLINICAL PRESENTATION AND DIAGNOSIS
- Esophageal rings
- - Initial therapy
- - Risk of recurrence
- - Benefit of acid suppression
- - Refractory rings
- Esophageal webs
- SUMMARY AND RECOMMENDATIONS