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For further information, see CMDT Part 17-19: Benign Esophageal Lesions

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

    • Esophageal 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

  • Most webs and rings are over 20 mm in diameter and are asymptomatic

  • Solid-food dysphagia, characteristically intermittent and not progressive, often occurs 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

  • Endoscopic electrosurgical incision: a minimum lumen diameter of 15–18 mm achieves symptom remission in most patients

  • A single dilation may suffice, but repeat dilations are often necessary

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

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