Esophageal Webs and Rings Clinical Presentation

Updated: Dec 21, 2019
  • Author: Xaralambos Zervos, DO, MS; Chief Editor: Philip O Katz, MD, FACP, FACG  more...
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Presentation

History

Most patients with rings and webs of the esophagus have no symptoms. Instead, esophageal webs and rings are detected incidentally on upper GI series and/or upper endoscopy.

The hallmark symptom of esophageal rings and webs is dysphagia. [26, 27] Dysphagia to solid food usually is greater than dysphagia to liquid food. If liquid dysphagia is the predominant symptom, suspect a motility disorder, such as achalasia, nutcracker esophagus, or diffuse esophageal spasm.

Suspect the presence of a symptomatic Schatzki ring in a patient older than 50 years with a chief complaint of intermittent dysphagia to solid food spanning months or years. Other supporting history for Schatzki rings includes heartburn and a hiatal hernia.

The anatomic location of the rings, webs, or narrowing structures causing dysphagia may be inferred from the patient's history. The clinician should ask the patient to locate the area of dysphagia along the sternum.

If the dysphagia is located below the sternum, then the obstruction site is likely in the mid-to-lower esophagus, and an excellent correlation exists between the patient's location and the anatomic obstruction site on barium study or endoscopy.

If the patient's area of dysphagia is located at or above the sternal notch, the obstruction site cannot be determined with any accuracy.

Alarming symptoms that are not consistent with esophageal rings are progressive dysphagia, weight loss, and anemia. These symptoms suggest a mechanical, fixed obstruction, such as a stricture or malignancy, making an early diagnosis mandatory.

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Physical Examination

Although most patients with esophageal rings and webs do not have any physical findings, the skin, mucous membrane, and nails may suggest an etiology.

In Paterson-Brown-Kelly syndrome (PVS), physical findings include koilonychia (spoon nails), cheilosis, and glossitis.

Rare skin diseases, such as epidermolysis dystrophica and benign mucous membrane pemphigoid, present with skin bullous lesions.

Acute caustic ingestion of lye or alkaline solution can lead to oropharyngeal injury manifested as ulcerations, exudates, edema, and erythema.

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