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Key Features

  • Esophageal webs are thin, diaphragm-like membranes of squamous mucosa typically in the mid or upper esophagus and may be multiple

    • May be congenital; also occur with eosinophilic esophagitis, graft-versus-host disease, pemphigoid, epidermolysis bullosa, pemphigus vulgaris

    • Web plus iron deficiency anemia is known as Plummer-Vinson syndrome

  • Esophageal rings are smooth, circumferential, thin (< 4 mm) mucosal structures in the distal esophagus at the squamocolumnar junction

    • Commonly associated with hiatal hernia

    • May be related to gastroesophageal reflux disease

Clinical Findings

  • Solid-food dysphagia, characteristically intermittent and not progressive, with rings < 13 mm in diameter

Diagnosis

  • Barium esophagogram with full esophageal distention

  • Endoscopy less sensitive for detection of subtle webs and rings

Treatment

  • Passage of large bougie dilators to disrupt the web or ring

  • Long-term proton pump inhibitor therapy for patients who have heartburn or who require repeated dilation

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