Esophageal Rings and Webs

Esophageal ring: A 2- to 4-mm mucosal structure, probably congenital, causing a ringlike narrowing of the distal esophagus at the squamocolumnar junction. Esophageal web: A thin membrane of squamous epithelium that occurs in the upper and mid esophagus.

Lower esophageal mucosal rings involve the mucosa and submucosa. The most common type is Schatzki's ring, which is composed of invaginated mucosa at the gastroesophageal junction, about 3 to 4 cm above the diaphragm. The incidence of esophageal webs increases with age.

Usually, esophageal rings are asymptomatic and may be associated with hiatus hernia. However, patients > 40 years are more commonly symptomatic for uncertain reasons. Nonprogressive, intermittent dysphagia is typical in patients with esophageal rings and webs. The symptoms usually occur when the diameter of the esophagus is decreased to < 12 to 13 mm. Dysphagia may begin when eating meat (referred to as "steakhouse syndrome"), often requiring regurgitation or liquids to expel or swallow the food.

Diagnosis and Treatment

A barium swallow can identify the lesion. Endoscopy can confirm the diagnosis. Symptoms that occur infrequently may be avoided through careful eating habits. Some patients respond to acid suppression with proton pump inhibitors or H₂ blockers. Others, however, require dilatation, usually with a single large bougie. Electrocautery incision of esophageal rings has also been used.