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Esophageal rings and webs

Authors
Gulchin A Ergun, MD
Peter J Kahrilas, MD
Section Editor
John R Saltzman, MD, FACP, FACG, FASGE, AGAF
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF

INTRODUCTION

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".)

DEFINITIONS

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 [1]:

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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Literature review current through: Nov 2016. | This topic last updated: Fri Jan 22 00:00:00 GMT+00:00 2016.
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References
Top
  1. Kahrilas PJ, Kim HC, Pandolfino JE. Approaches to the diagnosis and grading of hiatal hernia. Best Pract Res Clin Gastroenterol 2008; 22:601.
  2. SCHATZKI R. THE LOWER ESOPHAGEAL RING. LONG TERM FOLLOW-UP OF SYMPTOMATIC AND ASYMPTOMATIC RINGS. Am J Roentgenol Radium Ther Nucl Med 1963; 90:805.
  3. KEYTING WS, BAKER GM, MCCARVER RR, DAYWITT AL. The lower esophagus. Am J Roentgenol Radium Ther Nucl Med 1960; 84:1070.
  4. Wilcox CM, Alexander LN, Clark WS. Localization of an obstructing esophageal lesion. Is the patient accurate? Dig Dis Sci 1995; 40:2192.
  5. Mitre MC, Katzka DA, Brensinger CM, et al. Schatzki ring and Barrett's esophagus: do they occur together? Dig Dis Sci 2004; 49:770.
  6. Chen YM, Gelfand DW, Ott DJ, Munitz HA. Natural progression of the lower esophageal mucosal ring. Gastrointest Radiol 1987; 12:93.
  7. Müller M, Gockel I, Hedwig P, et al. Is the Schatzki ring a unique esophageal entity? World J Gastroenterol 2011; 17:2838.
  8. Nurko S, Teitelbaum JE, Husain K, et al. Association of Schatzki ring with eosinophilic esophagitis in children. J Pediatr Gastroenterol Nutr 2004; 38:436.
  9. Müller M, Eckardt AJ, Fisseler-Eckhoff A, et al. Endoscopic findings in patients with Schatzki rings: evidence for an association with eosinophilic esophagitis. World J Gastroenterol 2012; 18:6960.
  10. ELWOOD PC, JACOBS A, PITMAN RG, ENTWISTLE CC. EPIDEMIOLOGY OF THE PATERSON-KELLY SYNDROME. Lancet 1964; 2:716.
  11. Low DE, Hill LD. Cervical esophageal web associated with Zenker's diverticulum. Am J Surg 1988; 156:34.
  12. Ergun GA, Lin AN, Dannenberg AJ, Carter DM. Gastrointestinal manifestations of epidermolysis bullosa. A study of 101 patients. Medicine (Baltimore) 1992; 71:121.
  13. Foroozan P, Enta T, Winship DH, Trier JS. Loss and regeneration of the esophageal mucosa in pemphigoid. Gastroenterology 1967; 52:548.
  14. Kaplan RP, Touloukian J, Ahmed AR, Newcomer VD. Esophagitis dissecans superficialis associated with pemphigus vulgaris. J Am Acad Dermatol 1981; 4:682.
  15. McDonald GB, Sullivan KM, Schuffler MD, et al. Esophageal abnormalities in chronic graft-versus-host disease in humans. Gastroenterology 1981; 80:914.
  16. Sinha SK, Nain CK, Udawat HP, et al. Cervical esophageal web and celiac disease. J Gastroenterol Hepatol 2008; 23:1149.
  17. Novacek G. Plummer-Vinson syndrome. Orphanet J Rare Dis 2006; 1:36.
  18. Dinler G, Tander B, Kalayci AG, Rizalar R. Plummer-Vinson syndrome in a 15-year-old boy. Turk J Pediatr 2009; 51:384.
  19. Ouakaa-Kchaou A, Jebali S, Elloumi H, et al. [Association of Sjögren's syndrome and Plummer Vinson syndrome]. Rev Med Interne 2011; 32:e21.
  20. Ogunbiyi OA, El Tahir MI. Paterson-Brown Kelly syndrome. Ann Saudi Med 1996; 16:130.
  21. Hoffman RM, Jaffe PE. Plummer-Vinson syndrome. A case report and literature review. Arch Intern Med 1995; 155:2008.
  22. Ott DJ, Gelfand DW, Lane TG, Wu WC. Radiologic detection and spectrum of appearances of peptic esophageal strictures. J Clin Gastroenterol 1982; 4:11.
  23. Chen YM, Ott DJ, Gelfand DW, Munitz HA. Multiphasic examination of the esophagogastric region for strictures, rings, and hiatal hernia: evaluation of the individual techniques. Gastrointest Radiol 1985; 10:311.
  24. Smith DF, Ott DJ, Gelfand DW, Chen MY. Lower esophageal mucosal ring: correlation of referred symptoms with radiographic findings using a marshmallow bolus. AJR Am J Roentgenol 1998; 171:1361.
  25. Jouhourian C, Bonis PA, Guelrud M. Abdominal compression during endoscopy (the Bolster technique) demonstrates hidden Schatzki rings (with videos). Gastrointest Endosc 2016; 83:1024.
  26. Mann NS. Single dilation of symptomatic Schatzki ring with a large dilator is safe and effective. Am J Gastroenterol 2001; 96:3448.
  27. Chotiprasidhi P, Minocha A. Effectiveness of single dilation with Maloney dilator versus endoscopic rupture of Schatzki's ring using biopsy forceps. Dig Dis Sci 2000; 45:281.
  28. Wills JC, Hilden K, Disario JA, Fang JC. A randomized, prospective trial of electrosurgical incision followed by rabeprazole versus bougie dilation followed by rabeprazole of symptomatic esophageal (Schatzki's) rings. Gastrointest Endosc 2008; 67:808.
  29. Eckardt VF, Kanzler G, Willems D. Single dilation of symptomatic Schatzki rings. A prospective evaluation of its effectiveness. Dig Dis Sci 1992; 37:577.
  30. Sgouros SN, Vlachogiannakos J, Karamanolis G, et al. Long-term acid suppressive therapy may prevent the relapse of lower esophageal (Schatzki's) rings: a prospective, randomized, placebo-controlled study. Am J Gastroenterol 2005; 100:1929.
  31. Groskreutz JL, Kim CH. Schatzki's ring: long-term results following dilation. Gastrointest Endosc 1990; 36:479.
  32. DiSario JA, Pedersen PJ, Bichiş-Canoutas C, et al. Incision of recurrent distal esophageal (Schatzki) ring after dilation. Gastrointest Endosc 2002; 56:244.
  33. Marks RD, Richter JE. Peptic strictures of the esophagus. Am J Gastroenterol 1993; 88:1160.
  34. Raskin JB, Manten H, Harary A, et al. Transendoscopic electrosurgical incision of lower esophageal (Schatzki) rings: a new treatment modality. Gastrointest Endosc 1985; 31:391.
  35. Burdick JS, Venu RP, Hogan WJ. Cutting the defiant lower esophageal ring. Gastrointest Endosc 1993; 39:616.
  36. Roy GT, Cohen RC, Williams SJ. Endoscopic laser division of an esophageal web in a child. J Pediatr Surg 1996; 31:439.