Oesophageal rings or webs are thin, membranous folds of tissue that form in the oesophagus. These structures make the oesophagus narrower, blocking it either partially or fully.
The oesophagus is the tube that joins the mouth and throat to the stomach. Rings or webs can form anywhere in the oesophagus, but they are more common in the upper part of the oesophagus, which is closest to the throat.
Causes of Oesophageal Webs
The exact cause of oesophageal webs is unknown, but several factors may be involved with one of them being genetics. Others are thought to be associated with developmental abnormalities, iron deficiencies, inflammation or autoimmune disorders.
The medical conditions which are commonly associated with oesophageal webs include:
- Iron deficiency anaemia / Plummer-Vinson syndrome: People who have iron deficiency are more at risk to have oesophageal webs. Iron deficiency is a common type of anaemia that occurs due to lack of iron.
Without enough iron, the blood cells can’t carry oxygen to the body’s tissue. This causes symptoms such as exhaustion and fatigue. Women are at a greater risk of developing iron deficiency anaemia.
Plummer-Vinson syndrome (PVS) is a term that is used to describe iron deficiency anaemia that occurs alongside dysphagia and oesophageal rings and webs. It mostly affects women who are middle-aged or older. PVS is associated with the development of squamous cell carcinoma, which is a type of skin cancer.
- Gastroesophageal reflux disease (GERD): Some evidence suggests a link between (GERD) and the development of oesophageal rings and webs. GERD causes symptoms such as heartburn and an acidic or sour taste in the back of the mouth.
Symptoms of Oesophageal Webs
The most common symptom of an oesophageal web is difficulty in swallowing, and this is known as dysphagia. Dysphagia is also a symptom of a number of other conditions and experiencing it does not mean that you have an oesophageal web.
Oesophageal rings or webs can make a person feel like they’re about to choke when swallowing food. In other cases, they can make it difficult to swallow other substances such as liquids or pills.
Swallowed foods such as breads or meats might get caught in the web, creating a sensation that you have something stuck in your chest. You might cough so as to try to dislodge the food.
Dysphagia is associated with weight loss because difficulties in swallowing can make it hard to eat enough.
Other symptoms associated with oesophageal webs include:
- A sore tongue
- Cracks around the corners of the mouth
- Nasopharyngeal reflux
Diagnosis of Oesophageal Webs
- Barium swallow: A barium swallow helps in diagnosing an oesophageal web. During a barium swallow, you drink a white, chalky liquid then you get an X-ray done after that. The X-ray usually highlights the passage of the liquid through the gastrointestinal (GI) tract, making it easier for the doctor to see structural abnormalities.
- Upper GI endoscopy: The upper GI endoscopy is another procedure that can be used to identify an oesophageal web. During this procedure, a doctor uses a flexible instrument with a camera on its tip to see the inside of your oesophagus.
Treatment of Oesophageal Webs
Treatment of an oesophageal ring or web usually depends on the symptoms and cause. Oesophageal webs that do not cause symptoms usually do not require treatment. Individuals with mild symptoms may find that eating cutting food into smaller pieces or eating softer food is enough to relieve symptoms.
- In PVS cases, treatment addresses all symptoms, including iron deficiency anaemia, dysphagia and oesophageal webs. Sometimes, treating iron deficiency anaemia can reverse changes in the oesophagus and relieves dysphagia. Treatments for iron deficiency anaemia usually vary according to the severity and cause of anaemia. Some treatments include intravenous (IV) iron therapy and iron supplements.
- Oesophageal dilation can also be used to treat an oesophageal web. During an oesophageal dilation procedure, a dilator is used to stretch out the ringed or webbed part of the oesophagus. Local anesthetic is usually used during this procedure and the patient might have to stay at the hospital for a couple of hours afterward, but the recovery time is minimal.
- Endoscopic procedures are also used to treat oesophageal webs. They can include endoscopic laser division or electrocautery to remove the ring or web.
- Surgery is usually considered as a last resort in the treatment of oesophageal webs.
The outlook for individuals with oesophageal rings or webs with or without PVS is very good. Most individuals make a full recovery. After oesophageal dilation, symptoms such as difficulty swallowing usually disappear completely.
Oesophageal stenosis (oesophageal stricture) is the narrowing or tightening of the oesophagus, the tube that brings food and liquids from the mouth to the stomach. The condition is caused by surgical procedures, chronic inflammation, trauma, radiation, cancer, or it can be congenital (present at birth).
Any narrowing of the oesophagus can interrupt normal swallowing mechanisms causing difficulty in swallowing (dysphagia). The ability to pass food and liquid through the oesophagus can become impaired and create the inability to swallow or produce the feeling of fullness in the chest. Some people notice a pressure-like sensation that causes a shortness of breath which can either last for a short time, or prolonged time thereby requiring immediate medical attention.
Causes of Oesophageal Stenosis
It is believed that accidentally swallowing harsh chemicals, overproduction of stomach acid and other irritants can cause significant amount of damage to the esophageal lining leading to esophagitis (inflammation) and scar tissue. Repeated injury over time can cause the oesophagus to narrow to the point that prevents food and fluids from reaching the stomach.
Other causes of oesophageal stenosis (stricture) include:
- Consistent backups of gastric acid into the oesophagus or persistent GERD (gastroesophageal reflux disease)
- Swallowing corrosive chemicals including battery acid and household cleaners
- Treating oesophageal varices (enlarged oesophagus veins) which cause severe bleeding
- Systematic sclerosis (scleroderma) related to severe oesophageal stricture reflux
- Medication pills can also become lodged in the oesophagus and cause irritation
- Oesophageal cancer and other malignant conditions which narrow the oesophagus
- Prolonged use of the nasogastric feeding tubes during hospital stays
- Injuries which are caused by the use of an endoscope
- Radiation therapy to the chest or neck
- Achalasia whereby muscles at the end of the oesophagus gradually thicken
Frequent exposure to damaging stomach acid allows for the formation of scar tissue that will eventually narrow the oesophagus. People who are most at risk are those who suffer from GERD where the lower oesophageal sphincter can fail to tighten or close properly. This allows stomach acid to reflux (flow backwards) into the oesophagus and create a burning sensation that is felt in the lower chest that is typically described as heartburn.
Symptoms of Oesophageal Stenosis
The type of symptoms which are felt by the person suffering from oesophageal stenosis usually depend on the degree of the stricture, its location and cause. However, common oesophageal stenosis (stricture) symptoms include:
- Difficult, painful swallowing (dysphagia)
- Unexpected weight loss
- Chest pain and sensations of heartburn especially after consuming meals
- Throwing up blood
- Frequent burps or hiccups
- The feeling of something stuck in the throat or chest after a meal or swallowing pills
- Regurgitating liquids or food
- Increased salvation
Many of the symptoms can cause significant complications if the oesophageal stricture is not properly treated. This includes dense and solid foods becoming lodged deep within the oesophagus due to its narrowing. This can cause difficulty in breathing, sensation of chocking or chocking itself.
Other complications include dehydration and malnutrition because the person is not able to consume enough food and fluids due to the difficulty in swallowing. Without effective treatment, the person can experience pulmonary aspiration when food, fluid or vomit enters the lungs. If this condition goes uncorrected, the person will likely develop aspiration pneumonia – a bacterial infection that develops around the food, fluid or vomit that backed up into the lung.
Diagnosis of Oesophageal Stenosis
Oesophageal stenosis (stricture) can be first diagnosed after the patient discusses symptoms with their doctor. The doctor collects a detailed medical history and performs a comprehensive physical examination. If the doctor suspects stenosis of the oesophagus, he/she will likely refer the patient to a gastroenterologist who is an expert in G.I so as to rule out malignancy and confirm the diagnosis after a series of tests which include:
- Barium Oesophagram (swallow): This procedure requires a patient to swallow a barium thick liquid which temporarily coats the lining of the throat and oesophagus to produce clear, sharp imaging of the G.I. tract after an x-ray is taken.
- Upper G. Endoscopic: A flexible endoscope with a tiny camera attached is inserted into the oesophagus so as to allow a visual examination of the interior lining.
- Biopsy: A doctor takes a biopsy of the lesion that is causing the narrowing by using an endoscope. The biopsy is then examined under the microscope to determine the cause of the condition. However, this procedure is usually performed when there is suspicion of a malignant condition.
- Oesophageal Manometry: This is a procedure that measures the function of the lower oesophageal sphincter. But this procedure cannot be performed when the oesophageal stricture is extremely tight.
- Oesophageal PH Monitoring. Routine measurements of the upper G.I. tract PH balance can help in determining the amount of stomach acid that is refluxing (backing up) into the oesophagus. The test is performed by inserting a tube which passes from the mouth into the oesophagus that measures the PH levels over the course of 24hours.
Treatment of Oesophageal Stenosis
Treatment for oesophageal stenosis depends on the underlying cause and severity of the condition. The treatments include:
- Oesophageal Dilation: Doctors can dilate or stretch the interior of the oesophagus so as to alleviate common symptoms. However, there may be a need for this procedure to be repeated if the oesophagus continues to narrow months or years later.
- Oesophageal Stent Placement: A stent (thin expandable tube) is placed in the interior of the oesophagus to keep it from getting blocked and to allow the individual to swallow liquids and food.
- Changes in Diet choices and Lifestyle: Avoiding alcohol consumption, stopping smoking, consuming smaller meals, losing weight and elevating the upper torso to prevent acid reflux can reduce the chances of developing oesophageal stenosis.
- Medicines: Prescription proton pump inhibitors can help in managing the common side effects and symptoms associated with GERD so as to prevent the development of oesophageal stricture.
- Surgical options: These are the last options when oesophageal dilation and medication are ineffective.
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