eMedicine Specialties > Gastroenterology > Esophagus

Esophageal Webs and Rings: Follow-up

Author: Xaralambos Zervos, DO, MS, Clinical Fellow, Division of Hepatology, Center For Liver Diseases, University of Miami, Jackson Memorial Hospital
Coauthor(s): Nikolaos T Pyrsopoulos, MD, PhD, FACP, Chief of Hepatology, Medical Director of Liver Transplantation, Florida Hospital; Associate Professor of Medicine, University of Central Florida College of Medicine
Contributor Information and Disclosures

Updated: Nov 21, 2008

Follow-up

Further Inpatient Care

  • Esophageal rings and webs usually are managed in the outpatient setting.

Further Outpatient Care

  • Patients with recurrent symptoms from esophageal rings and webs require repeat esophageal dilation. Repeat esophageal dilation is safe and can relieve symptoms in the long term.

Inpatient & Outpatient Medications

  • Histamine type 2 (H2)-receptor antagonists, including cimetidine, famotidine, and ranitidine, may be used for mild-to-moderate GERD symptoms.
  • For severe GERD symptoms, proton pump inhibitors (eg, omeprazole, lansoprazole, rabeprazole, pantoprazole) are recommended.

Complications

  • Intermittent dysphagia to solid food is the most common complication.
  • Food impaction, particularly of meat products, is common in patients with lower esophageal rings. Signs of esophageal obstruction are dysphagia and an inability to swallow secretion. This is a medical emergency, and prompt endoscopy with removal of the obstructed food bolus is warranted. Intravenous glucagon is not an effective therapy. To prevent aspiration, barium studies are contraindicated in patients with suspected food impaction.
  • Spontaneous esophageal perforations have been reported for both esophageal webs and rings. The subgroup of patients who may be at risk of this rare complication is unclear.
  • Esophageal rings may progress to a stricture, possibly due to underlying GERD. Aggressive GERD management may be needed.
  • For unknown reasons, patients with PVS are at a higher risk of esophageal carcinoma.
  • Celiac disease may present as PVS. Test for antigliadin and antiendomysial antibodies. Duodenal biopsy is recommended in patients with PVS.

Prognosis

  • Prognosis in patients with mild symptoms is excellent because most respond to dietary modifications and change in eating habits.
  • Patients with refractory dysphagia usually respond to mechanical esophageal dilation.
  • Patients with recurrent dysphagia after dilation usually respond to repeat dilation. Surgery rarely is needed.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • All patients with dysphagia should receive an endoscopy to help establish the diagnosis. Barium radiography may not distinguish a benign from a malignant intraluminal abnormality of the esophagus. Endoscopy allows biopsy of lesions when any doubt exists.
  • Although no guidelines have been established for patients with PVS, screening upper endoscopy every 1-2 years for postcricoid malignancy is prudent.
 


More on Esophageal Webs and Rings

Overview: Esophageal Webs and Rings
Differential Diagnoses & Workup: Esophageal Webs and Rings
Treatment & Medication: Esophageal Webs and Rings
Follow-up: Esophageal Webs and Rings
Multimedia: Esophageal Webs and Rings
References
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Further Reading

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Keywords

esophageal webs and rings, esophageal webs, esophageal rings, rings and webs, contractile ring, contraction ring, benign annular stricture, lower esophageal muscular ring, multiple esophageal webs, multiple esophageal rings, MER, congenital esophageal stenosis, corrugated esophagus, feline esophagus, ringed esophagus, Schatzki ring, steak-house syndrome, steakhouse syndrome

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Contributor Information and Disclosures

Author

Xaralambos Zervos, DO, MS, Clinical Fellow, Division of Hepatology, Center For Liver Diseases, University of Miami, Jackson Memorial Hospital
Xaralambos Zervos, DO, MS is a member of the following medical societies: American College of Physicians, American Medical Association, and American Osteopathic Association
Disclosure: Nothing to disclose.

Coauthor(s)

Nikolaos T Pyrsopoulos, MD, PhD, FACP, Chief of Hepatology, Medical Director of Liver Transplantation, Florida Hospital; Associate Professor of Medicine, University of Central Florida College of Medicine
Nikolaos T Pyrsopoulos, MD, PhD, FACP is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Liver Foundation, American Medical Association, American Society of Gastrointestinal Endoscopy, American Society of Transplantation, International Liver Transplantation Society, and Transplantation Society
Disclosure: Gilead Sciences Honoraria Speaking and teaching; Schering-Plough Honoraria Speaking and teaching; Roche Honoraria Speaking and teaching

Medical Editor

Waqar A Qureshi, MD, Associate Professor of Medicine, Chief of Endoscopy, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine and Veterans Affairs Medical Center
Waqar A Qureshi, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Simmy Bank, MD, Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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