Esophageal Web Final 3b1zi

ABSTRACT

DISCUSSION

Esophageal webs are thin membranes located in the

Rings and webs are the most common structural

middle or upper esophagus. They are mainly observed

abnormalities in the esophagus. The terminology,

in the Plummer Vinson syndrome which is associated

pathogenesis, and treatment of these esophageal

with iron deficiency anemia. Its main symptoms are

lesions remain controversial. Esophageal rings usually

pain and difficulty in swallowing (odynophagia).

exist as a single lesion but can be multiple several

Esophageal webs are associated with bullous diseases

names have been coined for when multiple rings are

(such as epidermolysis bullosa, pemphigus and bullous

found in the esophagus, including multiple esophageal

pemphigoid) with graft versus host diseases involving

rings or webs, congenital esophageal stenosis, ringed

the esophagus and with celiac diseases.

esophagus,

A

case

of

esophageal

web

is

hereby

presented

corrugated

esophagus,

and

feline

esophagus.

manifesting as secondary candidial infection in 60

An esophageal web is a thin (2-3 mm), eccentric,

years old female with history of Dysphagia.

smooth

esophageal

tissue

typically is located in the anterior postcricoid area of

normal esophageal tissue consisting of mucosa and sub can

normal

anywhere along the length of the esophagus but

Esophageal webs are thin 2-3mm membranes of They

of

consisting of mucosa and sub mucosa that can occur

INTRODUCTION

mucosa.

extension

be

congenital

or

the proximal esophagus

acquired.

The pathophysiology of esophageal rings and webs is

Congenital webs commonly appear in the middle and inferior third of esophagus and they are more likely to be circumferential with a central or eccentric orifice. Acquired webs are much more common than congenital

a) Barium swallow examination revealed esophageal web with associated narrowing and mucosal irregularity in the lower

the formation of esophageal webs and rings. These

cervical and upper thoracic esophagus resembling neoplastic

include etiologies related to congenital origin, iron

lesion

deficiency,

webs and typically appear in the cervical area (post-

development,

inflammation,

and

autoimmunity.

Cricoid). Esophageal webs are more common in whites and in

controversial. Several theories have been proposed for

b) CT Scan showed circumferential narrowing of the proximal

The true prevalence of esophageal rings and webs is unknown. In patients with dysphagia, esophageal webs

esophagus

women with a ratio of 2:1.

can be found in 5-15% by barium radiography. Rings

CASE REPORT

and webs have been identified in all age cohorts. Patients do not typically become symptomatic until

A 60 years old Female patient presented with six-

after the age of 40

month history of progressive Dysphagia. It was more

Alarming symptoms that are not consistent with

for solids than liquids, episodic in nature with varying

esophageal rings are progressive dysphagia, weight

interval of freedom from symptoms. She also reported

loss, and anemia.

with weakness, fatigue, tachycardia and palpable

The

thyroid gland. She also had significant weight loss.

association

between

iron

deficiency

and

esophageal webs is controversial. Chisholm and Jacobs

IMAGING STUDIES

ed this association in 2 case series of 72 and

Ultra sound thyroid revealed multiple nodules in both

63 patients. However, a careful epidemiologic study by

the lobes. Findings were consistent of multi nodular

Elwood failed to show a correlation between iron

goiter. Barium swallow showed segment of irregular

deficiency

narrowing at C7, D1 and D2 level. Mucosa appeared eroded and ulceration was seen at this level. Shelf like indentation seen at C6-7 level. After the barium study patient

underwent

Endoscopy

twice

and

biopsy

revealed diffuse infiltration by chronic inflammatory

REFERENCES 3.Burdick JS, Venu RP, Hogan WJ: Cutting the defiant lower esophageal ring. Gastrointest Endosc 1993 Sep-Oct; 39(5): 616-9[Medline]. 4.Chen MY, Ott DJ, Donati DL, et al: Correlation of lower esophageal mucosal ring and lower esophageal sphincter pressure. Dig Dis Sci 1994 Apr; 39(4): 766-9[Medline]. 7.Hirano I, Gilliam J, Goyal RK: Clinical and manometric features of the lower esophageal muscular ring. Am J Gastroenterol 2000 Jan; 95(1): 43-9[Medline]. 9.Hoover WB: The syndrome of anemia, glossitis, and dysphagia. N Engl J Med 1935; 213: 394-8.

and

cervical

esophageal

webs.

Less

controversy is found between iron deficiency and dysphagia without webs. Iron deficiency clearly can precede dysphagia. Chisholm and Bredenkamp et al noted resolution of dysphagia but not webs after iron supplementation.

cells. 2nd Biopsy confirmed that mucosal erosion and

Barium swallow is the diagnostic test of choice and

ulceration was due to secondary candidial infection

should be the initial test in patients with dysphagia.