Introduction
Thin, membranous folds formed in the esophageal lumen that can make it narrow, partially or fully blocking it is referred to as esophageal rings and webs. Patients with esophageal rings and webs can be symptomatic (may not show any symptoms). They are the most common developmental abnormalities found in the esophagus.
What Are Esophageal Rings and Webs?
At times, there can be thin, membranous folds formed in the esophageal lumen that makes it narrow, partially or fully blocking it. These are referred to as esophageal rings and webs. Esophageal rings and webs can be formed in any part of the esophagus, though they are commonly seen in the upper esophagus near the throat. It makes it difficult to swallow food, though not many other noticeable symptoms might be observed.
What Are the Causes of Esophageal Rings and Webs?
The exact etiology or cause behind esophageal rings and webs is unknown, as several factors might be involved. Some of the causes include the following:
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Genetics.
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Developmental abnormalities.
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Iron deficiency.
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Inflammation.
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Autoimmune.
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Caustic ingestion (ingestion of strong acids or alkalies).
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An inflammation induced by some drugs.
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Mediastinal radiation (a type of radiation therapy used to treat cancer).
Which Are the Medical Conditions That Cause Esophageal Rings and Webs?
Medical conditions causing esophageal rings and webs include:
1. Iron Deficiency Anemia or Plummer-Vinson Syndrome (PVS)
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Esophageal rings and webs are found more in people with iron deficiency anemia (a type of anemia caused by iron deficiency).
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The blood cells cannot deliver sufficient oxygen to the tissues, as no adequate iron is required, which can result in fatigue and weariness.
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According to The National Heart, Lung, and Blood Institute, women are at an increased risk of developing iron deficiency anemia.
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The characteristics of Plummer-Vinson syndrome are the iron deficiency anemia that occurs along with dysphagia and esophageal rings and webs. It is usually seen in middle-aged or older women.
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PVS is also found to have associations with the development of squamous cell carcinoma (a type of skin cancer).
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The association between iron deficiency and esophageal rings is also unclear.
2. Gastroesophageal Reflux Disease (GERD)
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Some studies reveal a link between GERD and esophageal rings. The symptoms of GERD can include heartburn and a sour taste in the back of the mouth.
3. Celiac Sprue
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Also called gluten-sensitive enteropathy, it is a reaction of the immune system to the intake of gluten, a protein found in wheat, barley, etc.
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An association between celiac sprue and esophageal rings has been reported.
4. Inlet Patch
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An inlet patch is a congenital anomaly consisting of a red patch in the upper esophagus.
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Most inlet patches are asymptomatic, but some complications can cause esophagitis, esophageal web, etc.
5. Graft vs. Host Diseases.
6. Skin Diseases.
What Are the Symptoms of Esophageal Rings and Webs?
The most common symptom of esophageal rings and webs is dysphagia or difficulty swallowing food. Since dysphagia is a symptom of many other conditions, having dysphagia may not necessarily mean that one has esophageal rings and webs. Esophageal webs can give a feeling of choking while trying to swallow. Other symptoms include:
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Cracks around the corner of the mouth.
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A sore tongue.
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Nasopharyngeal reflux.
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Weight loss.
Weight loss can be associated with dysphagia since it would be difficult for the patient to swallow food.
How Are Esophageal Rings and Webs Diagnosed?
1. Laboratory Studies
Laboratory studies may only be necessary in some cases. However, it might be necessary to find out about iron deficiency anemia, celiac sprue, and Plummer-Vinson syndrome. The following tests are to be done:
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CBC Count: Complete blood count provides details on all blood cells in a person’s body.
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Iron Panel: Used to monitor liver function and nutrition.
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Ferritin: It is a protein in the blood that stores iron. This test shows how much iron is stored in the blood.
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Anti-gliadin Antibodies: These are IgA and IgG antibodies found in the serum of celiac patients.
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Anti-endomysial Antibodies: They are specific markers for celiac diseases.
2. Imaging Studies
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A barium swallow is an initial and diagnostic test of choice in patients with dysphagia. It helps to detect obstruction in the lumen of the esophagus.
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It is also called an esophagogram. It is an imaging technique using a special type of X-ray called fluoroscopy. It shows the organs moving in real time.
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The person undergoing this procedure is made to drink a chalky fluid containing barium.
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The presence of barium in the blood enables us to see the internal organs more clearly.
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A barium swallow is relatively safe, has low radiation exposure, and is relatively less expensive. It is considered more sensitive than endoscopy in finding out rings and webs.
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Reflux of barium helps to provide information about the lower esophageal sphincter (LES) and gastroesophageal reflux disease(GERD).
3. Procedures
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Esophagogastroduodenoscopy is a diagnostic procedure and helps to provide therapeutic intervention.
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It is less sensitive than a barium swallow, and often the clinician can miss the diagnosis of an esophageal web due to the fragility of the web, hypermotility of the esophagus, presence of excess secretion in the esophagus, etc.
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Allows biopsy of lesions like strictures, masses, polyps, etc., especially in malignancy.
4. Histologic Findings
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A normal squamous cell epithelium, hyperplasia of basal cells, hyperkeratosis, connective tissue proliferation, plasma cells, and lymphocytic infiltration are seen that suggest chronic inflammation in a histological slide of esophageal rings.
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Normal squamous cells with occasional inflammatory cells are seen in the histologic findings of esophageal webs.
How Are Esophageal Rings and Webs Treated?
The treatment of esophageal rings and webs depends upon the symptoms presented and the underlying cause, which is explained below.
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Esophageal webs that do not cause any symptoms may not require any treatment at all.
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People who show mild symptoms can find that eating soft food or cutting food into smaller bites helps solve their difficulty.
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In the case of Plummer-Vinson syndrome, the treatment should address concerns like dysphagia, iron deficiency anemia, and esophageal web.
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In some cases, treatment of iron deficiency anemia automatically resolves dysphagia and esophageal webs.
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Esophageal dilatation is another mode of treatment for esophageal webs and rings. This procedure might require local anesthesia while dilating the lumen using a dilator.
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Endoscopic procedures like laser division have also been used to treat esophageal rings and webs. Surgery can be considered a last resort.
Conclusion
The prognosis for esophageal rings and webs is good, as most people recover completely with treatment. In addition, symptoms like dysphagia are completely solved after an esophageal dilation.
