Esophageal rings and webs are folds that block your esophagus either partially or completely. Rings are bands of normal esophageal tissue that form constrictions around the inside of the esophagus. They occur in the lower esophagus. Webs, which arise in the upper esophagus, are thin layers of cells that grow across the inside of the esophagus. Either condition may make it difficult to swallow solid food.

Experts aren't sure what causes esophageal rings and webs. The condition may be congenital (inherited) or may develop after birth. People with esophageal rings and webs commonly have reflux symptoms. When esophageal webs occur together with iron deficiency anemia, the condition is known as Plummer-Vinson syndrome.

Most esophageal rings and webs do not cause any symptoms, and are discovered when people have barium X-rays or endoscopy for unrelated reasons. When rings or webs do cause symptoms, the most common complaint is difficulty swallowing solids. Foods, especially meats and breads, may feel like they get stuck in the same place.

Food occasionally can become lodged in the esophagus and require an endoscopic procedure to unblock the esophagus.

To determine if you have a ring or a web, your doctor may order one of these tests:

• Barium swallow test. This allows the radiologist to examine the esophagus with an X-ray. You will be required to swallow barium sulfate, a chalky drink, and may also be asked to swallow a pellet to see if it passes freely down to your stomach.



• Endoscopy. Your doctor inserts a tubelike camera through your mouth into your esophagus to examine it from the inside.

Webs are thin and pliable and may be difficult to detect. Your doctor may miss them with either test. One advantage of endoscopy is that your doctor may be able to widen an area of narrowing during the process, opening up the esophagus.

Treating the rings or webs usually solves your problem immediately. Webs and rings can come back, though, so you may need repeated treatments for them. Some people can live with the annoyance of rings and webs, and decide not to have treatment.

There is no way to prevent esophageal rings or webs. However, because this condition may be related to acid reflux or iron deficiency anemia, you can take measures to prevent and treat these disorders. Avoid foods that promote acid reflux, especially coffee, chocolate, fatty foods, spicy foods, carbonated beverages, peppermint, spearmint, citrus fruits, tomatoes, whole milk and onions. The treatment of iron deficiency anemia varies depending on the cause of the problem.

If you have acid reflux and rings or webs, treatment will be directed at improving the reflux. Because iron deficiency may contribute to the development of esophageal rings and webs, your doctor probably will order a blood test for iron levels and, if you are deficient, prescribe iron supplements.

If swallowing difficulties continue, you will be referred to a specialist who performs endoscopy and esophageal dilation. Dilation involves stretching and widening the narrowed part of the esophagus. The doctor first will locate the web or ring with the endoscope, then will insert a specially designed balloon through the scope to the narrowed area. The balloon will be inflated to stretch the rings and break up the webs.

A few people have rings in the lower esophagus that don't improve even after repeated dilation therapy. In this case, your doctor may suggest using electrocautery to reduce the size of the ring. This can be done through an endoscope using a special wire that can deliver an electric current directly to the extra tissue.

You should contact your doctor if you have any difficulty swallowing. You should seek emergency medical attention if you can't swallow liquids because food has lodged in your esophagus.

The outlook for esophageal webs and rings is excellent. Even people with difficulty swallowing do well after dilation. If symptoms keep returning, you may need repeat dilations or electrocautery to control the symptoms.

American College of Gastroenterology (ACG)
P.O. Box 3099
Arlington, VA 22302
http://www.acg.gi.org/

American Gastroenterological Association
4930 Del Ray Ave.
Bethesda, MD 20814
Phone: 301-654-2055
Fax: 301-654-5920
http://www.gastro.org/