The esophagus can be narrowed or completely blocked. In rare cases, the cause is hereditary (for example, congenital rings). In most cases, the cause is progression of an injury to the esophagus or tumor growth. Food and foreign bodies may obstruct the esophagus as well. Injuries that can progress to obstruction can result from damage caused by the repeated backflow of acid from the stomach (gastroesophageal reflux or GERD), usually over years. Injury can also result from damage caused by drugs taken in pill form or ingestion of corrosive substances (see see Injury to the Esophagus). Narrowing may also be caused by compression against the outside of the esophagus. Compression can result from a number of causes, such as enlargement of the left atrium of the heart, an aortic aneurysm, an abnormally formed blood vessel (dysphagia lusoria), an abnormal thyroid gland, a bony outgrowth from the spine, or cancer—most commonly lung cancer. Another serious cause of narrowing is noncancerous (benign) and cancerous (malignant) tumors of the esophagus.
Because all these conditions decrease the diameter of the esophagus, people with one of them usually have difficulty swallowing solid foods—particularly meat and bread. Difficulty in swallowing liquids develops much later, if at all.
A type of barium x-ray called a barium swallow (see see X-Ray Studies) is usually taken to find the cause and location of the narrowing or obstruction. Treatment and outcome depend on the cause.
Dysphagia lusoria is difficulty swallowing caused by compression of the esophagus by an abnormally formed blood vessel, which is present at birth.
Dysphagia lusoria is a birth defect. However, the swallowing difficulty may not appear until childhood or later in life because that is when degenerative changes occur in the abnormally formed blood vessel. A barium swallow x-ray shows the compression, but angiography (injecting a blood vessel with a dye that can be seen on x-rays) is necessary for an accurate diagnosis. Most people require no treatment, but surgical repair is sometimes performed.
Esophageal webs (also called Plummer-Vinson syndrome, Paterson-Kelly syndrome, or sideropenic dysphagia) are thin membranes that grow across the inside of the upper one third of the esophagus from its surface lining (mucosa).
Although rare, esophageal webs occur most often in people who have untreated severe iron deficiency anemia. Why anemia leads to the development of webs is unknown. Webs in the upper esophagus usually make swallowing solids difficult. A barium swallow x-ray is usually the best procedure with which to diagnose the problem.
Once the iron deficiency has been treated, the web usually disappears. If not, a doctor can rupture it using a dilator or an endoscope.
Lower Esophageal Ring
A lower esophageal ring (also called Schatzki's ring or B ring) narrows the lower esophagus and is most likely present at birth.
Normally, the lower esophagus has a diameter of 1½ to 2 inches (about 3½ to 5 centimeters). However, it may be narrowed to ½ inch in diameter (about 1¼ centimeters) or less by a ring of tight tissue, which may cause difficulty in swallowing solids. This symptom can begin at any age but usually does not begin until after age 25. The swallowing difficulty comes and goes and is especially aggravated by meat and dry bread. Often, barium swallow x-rays are done to show the ring.
Chewing food thoroughly followed by sips of water usually prevents symptoms. A doctor may fix the narrowing by passing an endoscope (a flexible viewing tube—see see Endoscopy) through the mouth and throat and into the esophagus or may use a dilator (called a bougie) to widen the passageway. In rare cases, the constricting ring is opened via a surgical procedure.
Last full review/revision October 2007 by Michael C. DiMarino, MD