Esophageal Webs & Rings

Key Features

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

  • 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 bougie or endoscopic balloon dilators to disrupt the web or ring

• A minimum lumen diameter of 15–18 mm achieves symptom remission in most patients

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