Esophagus

Esophageal Ring

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Esophageal Ring, Esophageal Web, Schatzki Ring, Esophageal A Ring, Esophageal B Ring

  • Types
  • Esophageal Ring
  1. Concentric swelling of tissue (2-5 mm) that protrudes into the esophageal lumen
  2. Typically occurs in the distal Esophagus, at the Lower Esophageal Sphincter (LES)
  3. Esophageal A Ring
    1. Esophageal smooth Muscle Contraction at distal Esophagus (proximal to the squamocolumnar junction)
  4. Esophageal B Ring
    1. Mucosal swelling in the distal Esophagus (at the squamocolumnar, gastroesophageal junction)
    2. Schatzki Ring (<12.5 mm diameter) is most common Esophageal B Ring
      1. Associated with Hiatal Hernia in most cases, as well as Eosinophilic Esophagitis
  • Types
  • Esophageal Web
  1. Thin (<2 mm), asymmetric esophageal protrusion into the esophageal lumen
    1. Extensions of mucosal and submucosal esophageal layers
    2. Typically in the proximal or middle Esophagus
  2. Associated Conditions
    1. Plummer-Vinson Syndrome (Iron Deficiency Anemia, Dysphagia, cervical Esophageal Web)
    2. Zenker's Diverticulum
    3. Bullous Conditions (Epidermolysis Bullosa, Bullous Pemphigoid, Pemphigus Vulgaris)
  • Symptoms
  1. Dysphagia for solids only
  2. Food impaction may occur
  • Diagnosis
  1. Barium swallow (barium esophagram)
  2. Upper Endoscopy (EGD)
  • Differential Diagnosis
  1. See Esophageal Dysphagia
  • Management
  1. Initial approach
    1. Biopsy Esophageal Rings (exclude Eosinophilic Esophagitis)
    2. Dilatation of Esophageal Ring
    3. Proton Pump Inhibitor (e.g. Omeprazole) for 6 weeks after esophageal dilation
  2. Refractory management
    1. Various measures under endoscopy have been used (e.g. intralesional Corticosteroid, incision, laser division)
  • References
  1. Ergon and Kahrilas in Saltzman (2020) Esophageal Rings and Webs, UpToDate, accessed 9/23/2020