X Ray with contrst of Webs and Rings Esophageal

                   Esophageal webs are thin membranes, 1 to 2mm in diameter, extending completely or partially around the esophageal lumen.Most webs occur singly and are located in the proximal esophagus along the anterior border. Some are part of a benign appearing stricture. Most smaller webs are incidental findings; more prominent ones are symptomatic. No definite association exists between the remaining esophageal lumen caliber and degree of dysphagia. Esophageal webs are amenable to balloon dilation; they are readily dilated with 20-mm diameter balloon catheters, a simple and effective therapy.

Upper esophageal webs. No underlying disease was found.

 

Plummer-Vinson Syndrome

               A combination of dysphagia, esophageal webs, and iron-deficiency anemia is characterized as the Plummer-Vinson syndrome. Patients are at increased risk of developing a postcricoid carcinoma. As already mentioned, these webs are readily dilated.

Epidermolysis Bullosa

               Epidermolysis bullosa, an inherited autosomalrecessive autoimmune disorder, is characterized by bullous lesions of the skin and bullae, erosions, and ulcerations in the oropharynx and esophagus. Occasionally the esophagus is involved with no cutaneous manifestations. These lesions heal by fibrosis and result in weblike rings. An association probably exists between epidermolysis bullosa and Crohn’s disease. These webs are readily balloon dilated, although therapy often results in hemorrhage and further fibrosis.

Pemphigoid

                Cicatricial pemphigoid, also known as benign mucous membrane pemphigoid, results in blistering lesions in the skin and mucous membranes. It rarely involves the esophagus, but when present esophageal blistering results in a web-like appearance, usually in the proximal portion. Some webs evolve into single or multiple strictures, and esophageal dilation is necessary.

                One patient with cicatricial pemphigoid was also found to have cervical esophageal intramural pseudodiverticulosis. Dilation, at times multiple, is required for dysphasia induced by these webs. Dilation in one patient led to an intramural dissection extending from the cervical esophagus to the esophagogastric junction.

Schatzki’s Ring

            Occasionally a web-like narrowing is detected at the distant end of the esophagus. Also called lower esophageal ring or mucosal ring, this narrowing contains not only mucosa but also other esophageal wall layers; it does not represent the squamocolumnar-mucosal junction. These rings, at most several millimeters in thickness,

are believed by some to be secondary to reflux esophagitis, although their precise etiology is unknown. They are more common in adults than in children. Their prevalence is difficult to gauge; many subtle ones are not detected on an esophagram without full distention.

          Occasionally recurrent upper esophageal webs and cricopharyngeal muscle spasms are associated with esophageal heterotopic gastric mucosa. Occasionally multiple esophageal webs are detected in a patient with dysphagia, but no predisposing condition is discovered; a congenital etiology is often ascribed. Although these patients respond to web dilation, dysphagia often recurs.

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