(See also Tumors of the GI Tract: Benign Esophageal Tumors and see Tumors of the GI Tract: Esophageal Cancer.)
Lower Esophageal Ring
(Schatzki's Ring, B Ring)
A lower esophageal ring is a 2- to 4‑mm mucosal stricture, probably congenital, causing a ringlike narrowing of the distal esophagus at the squamocolumnar junction.
These rings cause intermittent dysphagia for 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. Symptoms usually occur only when the esophageal lumen is < 12 mm in diameter and never when it is > 20 mm. If the distal esophagus is adequately distended, barium x‑rays usually show the ring. Instructing the patient to chew food thoroughly is usually the only treatment required in wider rings, but narrow-lumen rings require dilation by endoscopy or bougienage. Surgical resection is rarely required.
(Plummer-Vinson Syndrome; Paterson-Kelly Syndrome; Sideropenic Dysphagia)
An esophageal web is a thin mucosal membrane that grows across the lumen.
Rarely, webs develop in patients with untreated severe iron-deficiency anemia; they develop even more rarely in patients without anemia. Webs usually occur in the upper esophagus, causing dysphagia for solids. They are best diagnosed by barium swallow. Webs resolve with treatment of the anemia but can be easily ruptured during esophagoscopy.
Dysphagia lusoria is caused by compression of the esophagus from any of several congenital vascular abnormalities.
The vascular abnormality is usually an aberrant right subclavian artery arising from the left side of the aortic arch, a double aortic arch, or a right aortic arch with left ligamentum arteriosum. The dysphagia may develop in childhood or later in life as a result of arteriosclerotic changes in the aberrant vessel. Barium swallow shows the extrinsic compression, but arteriography is necessary for absolute diagnosis. Most patients require no treatment, but surgical repair is sometimes done.
Last full review/revision October 2007 by Michael C. DiMarino, MD